発作寛解後に脈絡膜剥離が生じた原発性急性閉塞隅角緑内障の1例

Choroidal detachment developed in a case of acute closed angle glaucoma

　急性閉塞隅角緑内障発作の寛解後に，短期間で高度な脈絡膜剥離と極度の浅前房を発生した稀な1例を報告した．

　脈絡膜剥離の発生には，発作時の著しい高眼圧と脈絡膜のうっ血，その後の薬物療法による急激な眼圧低下，毛様体の障害による低眼圧，炎症反応と血管壁透過性亢進，ピロカルピンの毛様筋収縮作用による上脈絡膜薄葉の解離などが関与し，さらに強膜の厚さと硬性，脈絡膜血管の脆弱性などの個体差も影響したものと考えた．

　急性閉塞隅角緑内障が薬物療法により急激に低眼圧となり，極度の浅前房がみられる場合には，脈絡膜剥離の合併がありうることに注意を要し，もし合併していれば上脈絡膜液の排除と周辺虹彩切除術，および前房内空気注入とを併用するのが良い．

A 68-year old female developed acute attack of closed angle glaucoma in her right eye. When seen by us the next morning, we observed mydriasis and glaukomflecken. The intraocular pressure (IOP) measured 80 mmHg. Intensive treatment with os-motic agents, systemic acetazolamide and topical pilocarpine brought IOP to 12 mmHg. Two days later, IOP decreased to 4 mmHg and the anterior chamber became very shallow. We observed chor-oidal detachment in the periphery along all the circumference.

We performed suprachoroidal tap, peripheral iridectomy and air injection into the anterior cham-ber.The following day, the anterior chamber waswell formed with 1OP at 12 mmHg. As probable of causes of choroidal detachment in the present case, we suspected ciliary congestion, sudden and extreme decrease of IOP, increased permeability of ciliary blood vessels and contrac-tion of the ciliary muscle induced by topical pilocarpine. Choroidal detachment may be present if extremely low IOP and persistent flat anterior chamber persist after relief of acute closed angle glaucoma attack.

In that case, treatment should include suprachor-oidal tap, peripheral iridectomy, and air injection into anterior chamber. Iridectomy alone may fail to build anterior chamber or might lead to malignant glaucoma.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(12) : 1383-1386, 1988