眼圧の季節変動がみられた緑内障患者の1例

Seasonal variations of intraocular pressure in a case of glaucoma

　9歳男児が原発開放隅角緑内障として紹介され受診した。4年前に喘息発作時にステロイド薬の吸引を行い，2か月前までアトピー性皮膚炎に対し手指にステロイド軟膏を塗布していた。左眼の視野障害が進行し，初診の2か月後と4年後に線維柱帯切除術を行った。右眼視野は正常であったが，初診の3年後から眼圧が上昇し，30mmHgを超え視野障害が起こった。初診から4年間の右眼眼圧は，夏に低く冬に高い傾向を周期的に繰り返していた。月ごとの平均眼圧は，7月が16mmHg，1月が約24mmHgで，冬のほうが高値であった。治療内容に変更がない成人の原発開放隅角緑内障18眼では，夏よりも冬のほうが眼圧が有意に高値であり，平均眼圧の差は1.2mmHgであった。緑内障の治療では，眼圧の季節変動を念頭におく必要がある。

　A 9-year-old boy was referred to us for primary open-angle glaucoma（POAG）. He had been treated by inhalation of corticosteroid for attacks of asthema since 4 years before. He had been receiving corticosteroid ointment for atopic dermatitis. We performed trabeculectomy on his left eye for progression of visual field defect 2months and 4 years later. His right eye started to show elevated intraocular pressure（IOP）3 years after his initial visit,occasionally exceeding 30mmHg. IOP in his right eye was generally higher in winter than in summer,averaging 16mmHg in July and 24mmHg in January. In another series of 18 adult eyes of POAG,IOP was significantly higher in winter than in summer with an average difference of 1.2mmHg. The findings show that treatment for glaucoma must be conducted with this seasonal variation in mind.