毛様体黒色細胞腫の続発緑内障に対して二期的手術を施行した1例

A case of glaucoma secondary to ciliary body melanocytoma treated by two-stage surgery

要約　目的：毛様体黒色細胞腫の続発緑内障に二期的手術を行った症例の報告。

症例：73歳，男性。眼圧降下薬を多剤併用するも左眼の眼圧コントロール不良のため当科を紹介され受診した。前房内に多量の黒色色素細胞を認め，5時方向の虹彩に隆起を認めた。前眼部光干渉断層計で5時方向の虹彩裏面に充実性腫瘤を認めた。毛様体黒色細胞腫による続発緑内障と臨床診断し，眼圧下降目的に初回手術として経強膜毛様体腫瘍摘出術を行った。病理検査結果は黒色細胞腫であった。術後も高眼圧が継続し，炎症の沈静した時期に，二期的手術として濾過手術を行い，無投薬で良好な眼圧コントロールを得た。

結論：毛様体黒色細胞腫の続発緑内障に対し，二期的に手術を計画することが有効な可能性がある。

Abstract　Purpose：To report a case of glaucoma secondary to ciliary body melanocytoma requiring a two-stage surgery.

Case：A 73-year-old man was referred to our hospital because of uncontrolled intraocular pressure（IOP）in his left eye even with the anti-glaucomatous medications. Slit-lamp examination of the left eye showed clumps of dark-brown pigmented cells in the anterior chamber angle and anterior bulging of the iris at the 5 o'clock position. Anterior segment optical coherence tomography（OCT） showed a solid mass beside the iris. The clinical diagnosis was secondary glaucoma resulting from ciliary body melanocytoma. The first operation was performed to achieve reduction in IOP involved transscleral excision of the tumor. Histopathologic examination revealed a melanocytoma. After the inflammatory response was controlled, trabeculectomy was performed as the second stage of two-stage operation in response to the continuously elevated IOP. Adequate IOP control was achieved in the left eye without the use of medication.

Conclusion：Two-stage surgery may be an effective treatment option for secondary glaucoma resulting from ciliary body melanocytoma.