網膜剝離手術30年後に発症した血管新生緑内障の1例

A case of neovascular glaucoma thirty years after retinal detachment surgery

要約　目的：網膜剝離手術から30年後に血管新生緑内障が発症した症例の報告である。症例：48歳の男性が左眼の眼圧コントロール不良で紹介され受診した。17歳のときに両眼の網膜剝離手術を受け，右眼が失明した。15か月前に左眼の白内障囊内摘出術を受け，0.5の視力になった。所見：矯正視力は右0，左0.1，眼圧は右30mmHg，左6mmHgであった。左眼には虹彩ルベオーシスと隅角全癒着が全周にあった。乳頭には緑内障性視神経萎縮と高い輪状締結術の所見があった。網膜剝離手術後の血管新生緑内障と診断し，複数回の緑内障手術と硝子体手術を行ったが，眼圧が再上昇し，視力が手動弁になった。結論：本症例での血管新生緑内障では，眼底周辺部の網膜剝離の残存，高い強膜内陥，白内障手術などが累加したことが原因となった可能性がある。

Abstract.　Purpose：To report a case who developed neovascular glaucoma 30 years after surgery for retinal detachment. Case：A 48-year-old male was referred for uncontrolled intraocular pressure（IOP） in his left eye. He had received surgery for retinal detachment in both eyes at the age of 17 years. His right eye became blind after surgery. He received intracapsular cataract extraction in the left eye 15 months before resulting in visual acuity of 0.5. Findings：His corrected visual acuity was no light perception right and 0.1 left. IOP was 30mmHg right and 6mmHg left. The left eye showed rubeosis iridis and total goniosynechia in whole circumference. The left eye showed glaucomatous optic atrophy and high scleral encircling. The condition was diagnosed with neovascular glaucoma following retinal detachment surgery. Multiple surgeries for glaucoma and vitrectomy resulted in elevated IOP and visual acuity of hand motion. Conclusion：Neovascular glaucoma in the present case may have been secondary to high scleral buckling, residual retinal detachment in the periphery, and cataract surgery.