硝子体手術併用の隅角癒着解離術が奏効した若年者の閉塞隅角緑内障の1例

Vitrectomy with goniosynechialysis was effective for angle-closure glaucoma in a young patient

要約　目的：閉塞隅角緑内障に対し，隅角癒着解離術を併用した硝子体手術が最終的に奏効した若年者の報告。症例：19歳女性が偶然に発見された高眼圧で受診した。裸眼視力は左右眼とも1.0，矯正視力は1.5であり，眼圧は右34mmHg，左25mmHgであった。両眼とも前房が浅く，隅角は右75％，左50％が閉塞していた。両眼にレーザー虹彩切開術を行い，点眼で眼圧が20mmHgに低下した。3か月後に右眼圧が44mmHgに上昇し，水晶体乳化吸引術，眼内レンズ挿入術，隅角癒着解離術を行った。眼圧は20mmHgに低下したが，隅角は全周が再癒着した。硝子体手術と隅角癒着解離術で隅角は全周が開放し，無点眼で眼圧が12mmHgになった。結論：本症例の閉塞隅角緑内障には水晶体よりも後方の要因が関与していると考えられる。隅角癒着解離術後に再癒着したとき，濾過手術ではなく硝子体手術と隅角癒着解離術をしたことで眼圧下降が得られた。

Abstract.　Purpose：To report angle-closure glaucoma in a young person that was successfully treated by vitrectomy with goniosynechialysis. Case：A 19-year-old female presented with elevated intraocular pressure（IOP）detected by chance. Findings：Corrected visual acuity was 1.5 in either eye. She had no hyperopia. IOP was 34 mmHg right and 25 mmHg left. Both eyes showed shallow anterior chamber. The chamber angle was closed along 270°of circumference in the right and 180°in the left. Laser iridotomy resulted in IOP 20 mmHg in both eyes. The right eye was treated by phacoemulsification-aspiration after rise of IOP to 44 mmHg 3 months later. IOP decreased to 20 mmHg but was followed by peripheral anterior synechia along the whole circumference. Another goniosynechialysis with vitrectomy resulted in open angle with IOP of 12 mmHg. Conclusion：Vitrectomy with another goniosynechialysis,instead of filtering surgery,induced success in this patient. Angle-closure glaucoma appears to have been due to factors posterior to the lens.