片眼の白内障手術後早期に両眼の著明な浅前房と高眼圧をきたした1例

A case of markedly shallow anterior chamber and high intraocular pressure in both eyes early after cataract surgery in one eye

要約　目的：片眼の白内障手術後当日に術眼および非術眼の毛様体浮腫，浅前房ならびに眼圧上昇をきたした症例を経験したので報告する。

症例：57歳，男性。右視力低下を主訴に受診した。両眼の核白内障および右後囊下白内障を認め，前眼部，眼底には特記すべき所見を認めなかった。視力は右（0.15），左（1.2），眼圧は右16mmHg，左18mmHg，前房深度は右3.46mm，左3.38mm，眼軸は右24.25mm，左24.07mmであった。

所見：右眼の超音波水晶体乳化吸引術，眼内レンズ（IOL）挿入術を行い，合併症なく終了した。術後3時間より頭痛，僚眼の霧視を自覚し，術後9時間で受診した。右IOLは囊内中央に固定され前房の炎症も軽度であったが，両眼とも著明な浅前房であり，眼圧は右70mmHg，左62mmHgと上昇していた。左眼の超音波生体顕微鏡検査で毛様体浮腫を認めた。D-マンニトール点滴とアセタゾラミド内服，眼圧下降薬点眼，アトロピン硫酸塩水和物点眼，ベタメタゾン0.1％点眼とプレドニゾロン20mg内服を開始し，術後10日目には前房深度と眼圧は正常化した。

結論：片眼の白内障手術後に両眼の眼圧上昇をきたし，眼圧下降薬点眼と散瞳・調節麻痺点眼，副腎皮質ステロイド薬で軽快した症例を経験した。薬剤性毛様体浮腫や眼炎症性疾患などの可能性が示唆される。

Abstract　Purpose：We report a case of ciliary body edema and elevated intraocular pressure（IOP）in the operated and nonoperated eye after monocular cataract surgery.

Case：A 57-year-old man presented with decreased visual acuity in the right eye. He had nuclear cataracts in both eyes, and a right posterior subcapsular cataract, without significant findings in the anterior segment or the fundus. The visual acuity was Vd＝（0.15）in the right eye, Vs＝（1.2）in the left, and IOP was 16 mmHg in the right eye and 18 mmHg in the left. The anterior chamber depth was 3.46 mm on the right eye and 3.38 mm on the left, and the ocular axis was 24.25 mm and 24.07 mm for the right and left eyes, respectively. Phacoemulsification and aspiration, and intraocular lens（IOL）insertion in the right eye were performed and completed without complications. At 3 hour postoperatively, the patient had foggy vision in both eyes, with a headache, and came to the hospital 9 hour postoperatively. The right IOL was fixed to the bag's center. The anterior chamber inflammation was mild. However both eyes had a markedly shallow anterior chamber with elevated IOP（70 mmHg in the right eye and 62 mmHg in the left）. Ultrasound biomicroscopic examination of the left eye showed ciliary edema；D-mannitol and acetazolamide medication, glaucoma eyedrops, mydriatic eyedrops, betamethasone 0.1％ eyedrops, and 20 mg prednisolone medication were started. The anterior chamber depth and IOP were normalized on postoperative day 10.

Conclusion：We report a case of elevated IOP in both eyes after cataract surgery in one eye, which responded well to glaucoma eyedrops, mydriatic eyedrops, and corticosteroids. The possibility of drug-induced ciliary edema or ocular inflammatory disease is suggested.