乳幼児期の小児緑内障眼における角膜形状および眼球形態

Curvature of the cornea and shape of the eyeglobe in infants and children with childhood glaucoma

要約　目的：乳幼児期の小児緑内障眼の角膜形状の特徴を明らかにすること。

対象と方法：2010年6月〜2015年12月の間に広島大学病院眼科において，全身麻酔下で精査した4歳未満の小児緑内障10例18眼（緑内障群），先天白内障12例15眼（白内障群）を対象とした。白内障群は，水晶体の混濁以外の異常がないものを選択して対照群とした。手持ち型オートレフラクトケラトメータを用いて平均角膜曲率半径を測定し，超音波画像診断装置を用いて前房深度と眼軸長をそれぞれ測定した。緑内障群と白内障群を対応のないt検定を用いて比較した。

結果：検査時月齢は緑内障群で9.9±11.1か月（0〜33か月），白内障群は14.6±9.0か月（2〜43か月）で有意差はなかった。眼圧は緑内障群28.0±11.8mmHg，白内障群10.5±5.0mmHgと緑内障群が有意に高かった（p＝0.0012）。前房深度は緑内障群3.78±0.48mm，白内障群3.24±0.36mmで，緑内障群が有意に深かった（p＝0.047）。眼軸長は緑内障群21.7±2.60mm，白内障群19.4±1.50mmで，緑内障群が有意に長かった（p＝0.0083）。平均角膜曲率半径は緑内障群7.43±0.54mm，白内障群7.60±0.52mmと有意差はなかった（p＝0.18）。

結論：乳幼児期の小児緑内障眼では，前房深度や眼軸長が伸長していた。しかし，平均角膜曲率半径は有意な変化がなかった。

Abstract　Purpose：To report the shape of the cornea and eyeglobe in infants and children with childhood glaucoma.

Cases and Method：This study was made on 18 eyes of 10 patients with childhood glaucoma and on 15 eyes of 12 patients with congenital cataract under 4 years of age. Cases were examined under general anesthesia during a 67-month period. Patients with cataract were selected when no abnormal change was present except lens opacity. Corneal curvature was measured using an autorefractor/keratometer. Ultrasonography was used to measure the depth of anterior chamber and length of ocular axis. The findings were evaluated by unpaired t-test.

Results：Age of glaucoma patients ranged from 0 to 33 months and averaged 9.9±11.1 months. Age of cataract patients ranged from 2 to 43 months and averaged 14.6±9.0 months. There was significant difference between the two groups. Intraocular pressure（IOP）of glaucoma patients averaged 28.0±11.8 mmHg and was significantly higher than IOP in cataract group that averaged 10.5±5.0 mmHg（p＝0.0012）. Depth of anterior chamber in glaucoma group averaged 3.78±0.48 mmHg and was significantly deeper than that in cataract group that averaged 3.24±0.36 mmHg（p＝0.047）. Axial length in glaucoma group averaged 21.7±2.60 mm and was significantly longer than that in cataract group that averaged 19.4±1.50 mm（p＝0.0083）. The corneal curvature averaged 7.43±0.54 mm in glaucoma group and 7.60±0.52 mm in cataract group. The difference was not significant.

Conclusion：The glaucoma group showed higher values of anterior chamber depth and ocular axis than cataract group. The two groups showed no difference in corneal curvature.