閉塞隅角緑内障を発症した瘢痕期未熟児網膜症の1例

Acute closed-angle glaucoma in a case of cicatricial retinopathy of prematurity

要約　5歳男児が前日からの右眼眼痛で受診した。在胎期間25週，出生体重624gの未熟児で，肺成熟不全症（Wilson-Mickity症候群）であった。生後7か月に，両眼に水晶体後部線維増殖と牽引乳頭があり，未熟児網膜症瘢痕期分類grade 4と診断された。眼圧は右60mmHg，左20mmHg，眼軸長は右17.4mm，左17.8mm，両眼とも浅前房であった。右眼の急性緑内障発作と診断した。両眼に周辺虹彩切除術を行い，眼圧は下降した。退院時の屈折は両眼とも-5Dの近視であった。2か月後に虹彩切除部が再閉塞し，眼圧が再上昇した。再度の周辺虹彩切除術で12か月後の現在まで眼圧は下降している。本症のような未熟児網膜症瘢痕期に生じる急性緑内障発作には，瞳孔ブロックや水晶体後部線維増殖組織による水晶体の前方移動以外の機序が関係している可能性がある。

Abstract.　A 5-year-old boy presented with pain in his right eye since the day before. He had been born premature with the gestation period of 25 weeks and birthweight of 624 g. He had developed Wilson-Mickity syndrome during infancy. He had been diagnosed with retinopathy of prematurity,cicatricial stage grade 4,on account of retrolental fibroplasia and dragged disc in both eyes. His intraocular pressure（IOP）was 60 mmHg right and 20 mmHg left. The axial length was 17.4 mm right and 17.8 mm left. Both eyes had shallow anterior chamber. We diagnosed the right eye as acute glaucomatous attack. Peripheral iridectomy induced normalization of IOP. Both eyes were myopic with-5 diopters each. Two months later,the IOP increased again following closure of iridectomy opening. Another iridectomy induced normalized IOP for 12 months until present. The findings suggest that acute closed-angle glaucoma in this case may have causes other than pupillary block or anteriorly displaced lens by the retrolental fibrotic tissue.