水晶体囊拡張リング併用眼内レンズ挿入眼に発症した急性隅角閉塞の2例

Acute angle closure caused by capsular tension ring and intraocular lens

要約　背景：水晶体囊拡張リング（CTR）挿入の合併症として隅角閉塞が生じたという報告は少ない。今回，CTR併用眼内レンズ（IOL）挿入眼に急性隅角閉塞を発症した症例を2例経験したので報告する。

症例1：患者は58歳，男性。来院半年前に前医で両眼CTR併用白内障手術を施行されている。右視力低下，高眼圧を認め，慶應義塾大学病院（以下，当院）を紹介され受診した。初診時矯正視力は右0.03，右眼圧46.3mmHgで，IOL偏位と全周性の隅角閉塞を認めた。CTRとIOLの複合体（CTR-IOL）を摘出し，硝子体切除術およびIOL強膜内固定術を施行したところ，術後の眼圧と視力は改善した。

症例2：患者は72歳，女性。来院3年前に前医で両眼CTR併用白内障手術を施行されている。右視力低下を認め，当院を紹介され受診した。右裸眼視力は0.4，眼圧は66mmHgで，IOLの下方偏位とこれに伴う上方の隅角閉塞を認めた。眼圧下降薬点眼，1％アトロピン点眼で保存的加療を行うも眼圧は高値を継続したため，CTR-IOLを摘出し，硝子体切除術，IOL強膜内固定術を施行したところ，術後の眼圧と視力は改善した。

結論：CTR挿入後の中長期合併症として急性隅角閉塞が生じる可能性がある。治療としてCTR-IOL摘出，硝子体手術，IOL強膜内固定術が有効であった。

Abstract　Background：There are few reports of angular closure as a complication of capsular tension ring（CTR）implantation. Here we experienced two cases of acute angular closure caused by a dislocated CTR-intraocular lens（IOL）complex（CTR-IOL）.

Case 1：The patient was a 58-year-old man. Six months earlier, he had undergone a cataract surgery with implantation of a CTR in another hospital. Owing to the decreased visual acuity and high intraocular pressure（IOP）in his right eye, the man was referred to our hospital. At the time of the visit, his best corrected visual acuity was 0.03 in the right eye, and his right IOP was 46.3 mmHg. IOL dislocation and all-circumferential angular closure were recognized. We performed CTR-IOL removal and IOL intrascleral fixation surgery. The visual acuity and IOP improved after the surgery.

Case 2：The patient was a 72-year-old woman. Three years before, she had undergone a cataract surgery with implantation of a CTR in another hospital. In December, she observed a decrease in the right eye visual acuity, and she came to our hospital. At the time of the visit, her right visual acuity was 0.4 without correction, and her right IOP was 66 mmHg. A downward shift of IOL and associated upward angle closure were observed. Initially, she was treated with IOP lowering eye drops and atropine eye drops, but the IOP continued to be high. Therefore, we performed CTR-IOL removal and IOL intrascleral fixation surgery. The visual acuity and IOP improved after the surgery.

Conclusion：The above cases imply that CTR implantation may cause secondary angle closure. In these situations, CTR-IOL removal and IOL intrascleral fixation surgery could be effective.