緑内障手術時に両眼の結膜下悪性リンパ腫が発見された続発緑内障の1例

A case of bilateral subconjunctival malignant lymphoma detected during surgery for secondary glaucoma

要約　目的：両眼の結膜下悪性リンパ腫が緑内障に対する手術中に発見された症例の報告。症例：72歳女性が緑内障の疑いで紹介受診した。両眼の霧視が2か月前からあり，隅角癒着が両眼にあり，眼圧上昇があった。所見：矯正視力は右0.9，左0.6で，眼圧は右36mmHg，左31mmHgであった。血液検査で白血球数が23,260/μlで，リンパ球の増加があった。1か月の間隔で両眼に線維柱帯切除術を行った。術中所見として，強膜上に癒着する淡茶褐色の組織があり，病理学的と遺伝子検査で結膜下悪性リンパ腫と診断された。結膜下の静脈周囲にリンパ球の浸潤があった。14か月後の現在まで，眼圧は正常域に維持されている。結論：両眼の結膜下悪性リンパ腫による静脈灌流障害が，本症例での眼圧上昇の原因であると推定される。

Abstract.　Purpose：To report a case of bilateral subconjunctival malignant lymphoma detected during surgery for secondary glaucoma. Case：A 72-year-old female was referred to us for suspected glaucoma. She had had blurring in both eyes since 2 months before. She had reportedly goniosynecha and elevated intraocular pressure（IOP）in both eyes. Findings：Corrected visual acuity was 0.9 right and 0.6 left. IOP was 36 mmHg right and 31 mmHg left. She showed leukocytosis of 23,260/μl with increase in lymphocytes. She received trabeculectomy in both eyes. As intraoperative finding, brown tissue mass was adherent to the sclera in either eye. The tissue was diagnosed with subconjunctival malignant lymphoma by pathological and gene analysis. Infiltration of lymphocytes was present around subconjunctival veins. IOP has remained in normal range for 14 months until present. Conclusion：This case illustrates that IOP may be elevated due to subconjunctival malignant lymphoma.