閉塞隅角緑内障を合併した真性小眼球の1例

A case of nanophthalmos with closed-angle glaucoma

要約　60歳男性が緑内障のコントロール不良のため紹介され受診した。幼少時から両眼の視力が不良であり，同胞5名中3名が視力不良であった。視力は右0.08×＋18D，左0.09×＋17Dであり，眼圧は右21mmHg，左42mmHgであった。角膜径は左右とも11mmで，眼軸長は右15.4mm，左15.6mmであった。両眼とも前房が著しく浅く，狭隅角で，膨隆虹彩があった。以上のことから，閉塞隅角緑内障を伴う真性小眼球と診断した。右眼に周辺虹彩切除術，左眼に線維柱帯切除術，超音波乳化吸引術，眼内レンズ挿入術を行った。術後，右眼には合併症がなく，左眼には局所的な脈絡膜剝離が生じたが自然消退した。右眼は点眼併用，左眼は無治療で眼圧が正常化し，視野狭窄の進行はない。真性小眼球に内眼手術を行うと，uveal effusionが起こりやすいとされているが，ほぼ順調に経過した症例である。

Abstract.　A 60-year-old male was referred to us for uncontrollable glaucoma. He had poor vision since childhood. His visual acuity was 0.08 corrected by＋18D right and 0.09 corrected by＋17D left. His intraocular pressure（IOP）was 21 mnHg right and 42 mmHg left. The corneal diameter was 11 mm in either eye. The axial length was 15.4 mm right and 15.6 mm left. Both eyes showed extremely shallow anterior chamber,iris bombe,and almost closed angle. These findings led to the diagnosis of nanophthalmos with closed-angle glaucoma. The right eye was treated by peripheral iridectomy and the left eye with trabeculectomy,phacoemulsification-aspiration and intraocular lens implantation. Postoperatively,there was no complication in the right eye. The left eye developed localized choroidal detachment that disappeared spontaneously. The IOP has been well-controlled in the right eye with medication and in the left eye without. This case illustrates that intraocular surgery in nanophthalmic eye may not induce uveal effusion contrary to the accepted view.