水晶体偽落屑物質の出現をみた原発緑内障症例の検討

Later appearance of pseudoexfoliation in eyes with primary glaucoma

　熊大眼科にて経験した水晶体嚢緑内障245例のうち，原発緑内障が先行し，水晶体偽落屑物質（PE material）が遅れて出現した症例が22例（9％）含まれていた．PE material出現前の診断の内訳は原発開放隅角緑内障（POAG）10例，原発閉塞隅角緑内障（PACG）12例であり，緑内障診断からPE出現までの期間は平均9年であった．これらの症例の90％に緑内障又は白内障手術の既往があった．PE materialの初発部位はPOAGでは瞳孔縁，PACGでは水晶体前面が多かった．

　POAG＋PE群の特徴は，緑内障進行眼，高度の隅角色素沈着眼であった．PACG＋PE眼ではこれらの特徴はみられず，両者の間には発生病態上差異のあることが予想された．

　PE material出現後，眼圧のコントロールが不良となる症例が50％にみられたことより，原発緑内障眼におけるPE materialの出現とその後の眼圧動態には厳重な注意を払うべきであると考えた．

We observed 22 patients who manifested pseudoexfoliative (PE) material after the initial diagnosis as primary open-angle glaucoma (POAG) 10 cases, or primary angle-closure glaucoma (PACG) 12 cases. This series comprised 9% of cases diagnosed as capsular glaucoma by us. The mean interval between diagnosis of glaucoma and detection of PE material was 9 years.

Glaucoma and/or cataract surgery preceded the detection of PE material in 90% of the series. PEmaterial was prone to be located alog the pupillary margin in POAG eyes and on the lens surface in PACG eyes. Appearance of PE materials in POAG eyes was associated with advanced glaucomatous changes and with moderate to heavy trabecular pigmentation. These features were absent in cases with PACG.

The control of intraocular pressure became poor after appearance of PE material in 50 % of the cases. We advocate due attention in the detection of PE materials in the follow-up of glaucoma patients.

Rinsho Lanka (Jpn J Clin Ophthalmol) 42(4) : 377-381, 1988