両眼レーザー虹彩切開術後に白内障手術未施行眼のみ角膜内皮細胞密度が減少した1例

Corneal endothelial cell density decreased in one eye after laser iridotomy and remained the same in the fellow eye after laser iridotomy and cataract surgery

要約　目的：両眼にレーザー虹彩切開術が行われ，1眼では角膜内皮細胞が減少し，白内障手術を受けた他眼では減少しなかった症例の報告。症例：68歳女性が両眼の霧視と眼痛で受診した。浅前房で散瞳により眼圧が上昇し，両眼の原発閉塞隅角緑内障と診断し，両眼にレーザー虹彩切開術を行った。その4年後に右眼に白内障手術を行った。その直前の角膜内皮細胞密度は右3,133/mm²，左3,123/mm²であった。その6年後に左眼の虹彩切開窓付近に角膜上皮浮腫があった。角膜内皮細胞密度は右3,791/mm²，左288/mm²であった。左眼に白内障手術を行い，以後20か月間角膜内皮に著変はない。結論：レーザー虹彩切開術後に角膜内皮細胞が減少する可能性がある。白内障手術は内皮細胞の減少阻止に有効であった可能性がある。

Abstract.　Purpose：To report a case who received laser iridotomy in both eyes. Corneal endothelial cell density decreased in one eye and remained the same in the other that underwent cataract surgery. Case and Findings：A 68-year-old female presented with blurring and pain in both eyes. Both eyes had shallow anterior chamber. Intraocular pressure rose after mydriasis,leading to the diagnosis of primary angleclosure glaucoma. Both eyes received laser iridotomy. The right eye underwent cataract surgery 4 years later. The corneal endothelial cell population before surgery was 3,133/mm² right and 3,123 mm² left. The left eye showed corneal edema at the site facing the iridotomy another 6 years later. The corneal endothelial cell population was 3,791/mm² right and 288/mm² left. The left eye was treated by cataract surgery. There has been no changes in corneal endothelial cell population for 20 months until present. Conclusion：There is a possibility that laser iridotomy may induce reduction of corneal endothelial cell population. Cataract surgery may prevent impairment of corneal endothelial cells.