毛様体悪性黒色腫に伴うmelanomalytic glaucoma

A case of melanomalytic glaucoma caused by malignant melanoma in the ciliary body

　今回我々は毛様体悪性黒色腫に緑内障を合併した症例に遭遇した．症例は33歳女性で，左眼視力低下および視野狭窄を訴え来院した．左視力0.8，左眼圧45mmHg．左眼5時方向の毛様体に6×4×3mm大の腫瘤が認められた．左眼隅角には黒色の色素沈着が認められた．組織学的には腫瘤は，一部類上皮細胞が散在する紡錐型細胞が主である壊死性変化の強いmixed typeの悪性黒色腫であった．また，隅角はメラニンを貪食した多数のマクロファージで閉塞され，これが眼圧上昇の原因と推察された．1970年Yanoffが毛様体悪性黒色腫に緑内障を合併した症例を報告し，これをmelanomalytic glaucomaと称した．今回の我々の症例は，まさにmelanomalytic glaucomaと称するにふさわしい症例で，本邦において初めてと思われるためここに報告した．

A 33-year-old female complained of decreased vision and visual field defect in her left eye. In the left eye, visual acuity was 0.8, intraocular pressure was 45 mmHg and glaucomatous visual field defect was present. The anterior chamber angle was wide open with black pigment deposits around 360 degrees. After mydriasis, a dark-brown tumor pressing the lens was detected

In the ciliary body at 5 o'clock position. The opticdisc had glaucomatous cupping. The clinical diagno-sis of malignant melanoma was further supported by ultrasonography, pantoscopy and CT scanning.

After enucleation, the tumor was diagnosed as malignant melanoma of mixed cell type with ne-crosis. The cause of glaucoma was identified as obstruction of the trabecular meshwork with melanin-laden macrophages. To our knowledge, this report of melanomalytic glaucoma caused by malignant melanoma in the ciliary body is the first in Japan.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(8) : 907-910, 1987