球状水晶体による続発閉塞隅角緑内障の診断に前眼部光干渉断層計が有用であった1例

Anterior segment optical coherence tomography facilitated the diagnosis in a case of spherophakia with angle-closure glaucoma

要約　目的：球状水晶体症例の診断に前眼部光干渉断層計（OCT）が有用であった症例の報告。

症例：55歳，女性。前日の昼から続く左眼の眼痛にて受診。左眼の眼圧は53mmHgで，眼所見から急性原発閉塞隅角症と考えられ，レーザー虹彩切開術を施行し眼圧は下降した。両眼とも−12D前後の強度近視で，浅前房であった。強度近視眼に特徴的な眼底所見は認めず，眼軸長は24.4mmで，前眼部OCTでは球状の水晶体が観察され，球状水晶体および続発閉塞隅角緑内障と診断した。

結論：球状水晶体は毛様小帯の脆弱性に起因する合併症をきたしやすいため，原発閉塞隅角緑内障と区別して経過観察を行う必要がある。前眼部OCTは診断に有用であった。

Abstract　Purpose: To report a case of spherophakia with angle-closure glaucoma in whom anterior segment optical coherence tomography（OCT）facilitated the diagnosis.

Case: A 55-year-old female presented with pain in the left eye since the day before. Intraocular pressure（IOP）was 11 mmHg in the right eye and 53 mmHg in the left. Both eyes showed shallow anterior chamber. Laser iridotomy in the left eye was followed by normalized IOP the next day. Visual acuity improved to 0.8 when corrected by −11.5 diopters. Fundus findings characteristic to myopia was absent in either eye. Both eyes showed axial length 24.4 mm. Anterior segment OCT showed spherophakia. The present case was eventually diagnosed with angle-closure glaucoma secondary to spherophakia.

Conclusion: This case illustrates that spherophakia may develop complications due to fragile zonules. Anterior segment OCT was useful in the diagnosis.