観血的手術の既往なく生じた悪性緑内障の1例

A case of malignant glaucoma following laser iridotomy

　悪性緑内障は，主に観血的手術の重篤な術後合併症として知られているが，我々は観血的手術の既往なく発症した1例を経験した．

　症例　は52歳の男性で，数年来の片眼の近視化と，眼圧上昇があり，他医でレーザー虹彩切開術を施行されていた．前房は極めて浅く，散瞳により前房深度の増加を認めた．周辺虹彩前癒着は認められず，毛様突起の腫脹と前方偏位，前硝子体膜の水晶体後面，毛様突起後面への密着を認めた．

　本症の発症機序としてciliary blockの概念があるが，本症例では毛様突起，水晶体，硝子体の三者間がwater tightとは考え難い事，房水流出率に低下を認めなかった事等から，硝子体から後房への流出抵抗増大，または，硝子体の液体透過性の低下によって発症したものと推察した．

A 52-year-old male developed acute angle closureglaucoma in his right eye. Laser iridotomy was perform-ed with initial success to the right eye and, pro-phylactically, to the left eye. Persistent elevation of intraocular pressure with extreme shallow anterior chamber developed in the right eye 8 weeks later and the patient was referred to us.

On examination, we observed extreme shallow ante-rior chamber of the right eye, intraocular pressure of 28 mmHg under maximum medical treatment and facility of outflow of 0.47. After mydriasis, the anterior cham-ber became deep with the chamber angle open. The ciliary processes were swelled and were displaced anter-iorly. The anterior vitreous surface was compressed against the posterior surface of the lens and the ciliary processes. This case thus failed to reveal increased outflow resistance, evidence of angle closure nor water-tight adhesion between the lens and the ciliary proces-ses in spite of the presence of malignant glaucoma. Changes in the vitreous permeability or resistance in flow of fluid from the vitreous to the posterior chamber seemed to have played a possible etiological role.