晩発性に急性緑内障発作を起こした後部型第一次硝子体過形成遺残と考えられる1例

A adult developed acute glaucoma associated with persistent hyperplastic primary vitreous

　晩発性に急性緑内障発作を起こした後部型第一次硝子体過形成遺残と考えられる31歳男性の症例について報告した．前部型第一次硝子体過形成遺残に伴う閉塞隅角緑内障は従来より報告されているが，本症例は術後の超音波検査で小眼球症が推察されたが，水晶体後部線維血管膜や毛様体突起の延長は明確ではなく，前部型第一次硝子体過形成遺残の合併を示唆する所見は乏しかった．

　眼底には乳頭から前部硝子体，毛様体近傍に至る硝子体中の索状物を認め，さらに黄斑部領域の色素性の網脈絡膜の変化，および網膜血管の白鞘化などから後部型第一次硝子体過形成遺残に発症した急性緑内障と思われた．

　摘出水晶体は比較的小さいが厚みをもっており，膨脹白内障に，小眼球に伴いやすい浅前房が影響した結果，緑内障発作を招来したものと考えた．

A 31-year-old man was admitted to us because of acute attack of angle closure glaucoma in his left eye since the day before. The glaucoma did not respond to medical treatment, apparently due to intumescent cataract. We removed the crystalline lens, which was totally opaque, thick and small in size. The posterior capsule was free of fibrous attachments suggestive of anterior persistent hyperplastic primary vitreous (PHPV).

Funduscopically, we indentified an elongatedintravitreal stalk from the optic disc reaching, anteriorly, the region corresponding to the anterior vitreous and the ciliary body. The terminal portion of the stalk appeared as a fibrous tissue. As addi-tional funduscopic findings, we observed pigmented chorioretinal patches in the macular area and sheathing of retinal vessels.

From the above findings, we concluded the case as the posterior form of PHPV, associated with spherophakia which induced the acute attack of angle closure glaucoma.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(5) : 585-588, 1988