Japanese
English
- 有料閲覧
- Abstract 文献概要
- 1ページ目 Look Inside
- 参考文献 Reference
要約 目的：近年，難治性緑内障に対してバルベルト緑内障インプラント（BGI）の有効性は報告されているが，水痘・帯状疱疹ウイルス（VZV）によるぶどう膜炎の続発緑内障（SG）に対するBGI施行の報告はほとんどない。今回，VZVによるSGに対してBGIを施行し，良好な眼圧コントロールを得られた1例を経験したので報告する。
症例：35歳，男性。右眼充血，霧視を主訴に前医を受診，ぶどう膜炎の疑いで当科を紹介され受診。初診時の右眼矯正視力は0.9，右眼眼圧は42mmHg，前房内細胞，角膜後面沈着物を認めた。前房水PCR検査の結果，VZV虹彩毛様体炎によるSGと診断した。バラシクロビルの全身投与，アシクロビル眼軟膏および眼圧下降薬の点眼で眼圧下降を認めたが，来院3週目に眼圧36mmHg，血管新生緑内障が併発し，ベバシズマブ硝子体投与（IVB）を施行した。IVB後，いったん眼圧は下降するも，その後は高眼圧が続き，結膜および毛様充血が持続したため，線維柱帯切除術の効果が期待できないと判断し，前房挿入型BGIを施行した。術1年後，眼圧下降薬点眼下で眼圧は15mmHg程度である。
結論：VZVに起因するSGに対して，BGIは短期的には有効であった。今後，長期経過観察が必要であると考えられる。
Abstract Purpose：Recently, the Baerveldt glaucoma implant（BGI）has been reported as an effective therapeutic approach for refractory glaucoma. There are no reports of a BGI being placed in patients with secondary glaucoma（SG）due to varicella-zoster virus（VZV）uveitis. We report a case with SG due to VZV in which the BGI was placed following good intraocular pressure（IOP）control after the operation.
Case：A 35-year-old man consulted our clinic with a complaint of conjunctival infection and blurred vision. He was diagnosed with uveitis and was referred to our hospital. The best-corrected visual acuity in the right eye was 0.9, IOP was 42 mmHg, and cells and keratic precipitates were observed in the anterior chamber at initial examination. SG due to VZV was diagnosed by means of polymerase chain reaction of the fluid in the anterior chamber. Nevertheless, IOP reduction was observed after administering systemic valacyclovir, acyclovir eye ointment, and IOP hypotensive eye drops. Neovascular glaucoma occurred after 3 weeks, and the IOP increased to 36 mmHg. An intravitreal anti-vascular endothelial growth factor（VEGF）injection was performed. After the injection of anti-VEGF, the IOP reduced for a while；however, it increased again, and the high IOP, anterior inflammation, and ciliary infection continued. The BGI was performed because the conventional trabeculectomy was considered ineffective in this case. The IOP reduced progressively to approximately 15 mmHg by 1 year after the operation.
Conclusion：BGI might be effective for SG due to VZV in the short-term. Long-term studies are required to confirm this finding.
Copyright © 2021, Igaku-Shoin Ltd. All rights reserved.
