エクスプレス®に膜様組織が付着し眼圧上昇した1例

Elevation of intraocular pressure in a case with adhesion of membranous tissue to inserted Ex-PRESSTM device

要約　目的：緑内障眼に挿入したエクスプレス^®が虹彩に癒着し，房水流出口が閉塞して眼圧が上昇した症例の報告。症例：開放隅角緑内障がある79歳女性の右眼圧が30mmHgに上昇し，エクスプレス^®挿入による線維柱帯切除術と白内障手術を同時に行った。眼圧は8〜16mmHgで安定したが，15か月後に20mmHgに上昇した。エクスプレス^®が虹彩に癒着し，房水流出口が閉塞していた。虹彩にアルゴンレーザーを照射し，虹彩と房水流出口にNd：YAGレーザーを照射した。エクスプレス^®と虹彩との癒着が解除され，房水流出口の膜様組織は消失し，眼圧は15mmHgに下降した。以後12か月間の経過は良好である。結論：緑内障眼に挿入したエクスプレス^®が虹彩に癒着し，房水流出口が閉塞して眼圧が上昇した症例にレーザー照射が奏効した。

Abstract.　Purpose：To report a case of elevated intraocular pressure（IOP）due to adhesion of Ex-PRESS^TM device to the iris and closure of aqueous outflow channel by membranous tissue. Case：A 79-year-old female developed IOP elevation to 30 mmHg in the right eye due to primary open-angle glaucoma. She received simultaneous cataract surgery and insertion of Ex-PRESS^TM device. IOP decreased to 8 to 16 mmHg. IOP rose to 20 mmHg 15 months later. The inserted Ex-PRESS^TM device was adherent to the iris and the aqueous outflow channel was blocked by membranous tissue. Irradiation of the iris and site of aqueous outflow was irradiated by argon and Nd：YAG laser. IOP decreased to 15mmHg during the following 12 months until present. Conclusion：Laser irradiation was effective for elevated IOP due to adhesion of Ex-PRESS^TM device to the iris and closure of aqueous outflow channel by membranous tissue.