未熟児網膜症と全身麻酔が関与した小児の急性閉塞隅角緑内障の1例

Acute angle-closure glaucoma in a child associated with retinopathy of prematurity and general anesthesia

要約　目的：未熟児網膜症（以下，ROP）の既往があり，全身麻酔後に急性閉塞隅角緑内障をきたした小児の報告。症例：6歳女児が全身麻酔手術翌日から持続する左結膜充血で受診した。両ROPの治療歴があり，抗てんかん薬を内服していた。所見：初診時の眼圧は右20mmHg，左50mmHg。両眼とも浅前房で，左眼に毛様充血，中等度の瞳孔散大を認めた。左眼の急性閉塞隅角緑内障と診断し，両眼の周辺虹彩切除術を施行し，眼圧は下降した。超音波生体計測では，浅前房と厚い水晶体を認めた。結論：ROP歴があり，浅前房や厚い水晶体を有する小児は，全身麻酔を契機に急性閉塞隅角緑内障を発症する危険性があり，発症時には成人の緑内障発作に準じた治療が必要である。

Abstract.　Purpose：To report acute angle-closure glaucoma following general anesthesia in a child with history of retinopathy of prematurity. Case：A 6-year-old girl was referred to us for conjunctival injection in her left eye that persisted since day 2 of surgery for dislocated hip joint under general anesthesia 16 days before. She had had cerebral palsy and epileptic attacks since being born premature with gestation of 26 weeks and birthweight of 868 g. Findings and Clinical Course：Intraocular pressure（IOP）was 20 mmHg right and 50 mmHg left. The left eye showed ciliary injection, corneal stromal edema and moderately dilated pupil. Ultrasound biomicroscopy showed shallow anterior chamber and thickening of the lens in both eyes. The findings led to the diagnosis of acute angle-closure glaucoma in the left eye and narrow chamber angle in the right. Both eyes received peripheral iridectomy followed by normalization of IOP. Conclusion：This case illustrates that acute angle-closure glaucoma may develop following general anesthesia in a child with history of retinopathy of prematurity, due probably to thickening of the lens and shallow anterior chamber. Peripheral iridectomy may be effective for such an attack of glaucoma.