増殖性変化のない未熟児網膜症治療眼に発症した急性緑内障発作の1例

Acute glaucoma attack occurring in a case of retinopathy of prematurity（ROP）treated eye without proliferative changes

要約　目的：網膜光凝固術と抗血管内皮増殖因子硝子体内注射で鎮静化し，増殖膜のない未熟児網膜症（ROP）で，急性緑内障発作が発症した症例の報告。

症例：7歳，女児。在胎週数25週2日，体重483gで出生。Aggressive ROPに対して治療を受けたのち網膜症は落ち着いていたが，全脳萎縮のため頭蓋骨・眼窩骨の発育不全があった。左眼の結膜充血と浮腫が急激に発生し，左眼圧41mmHg，両眼の前房がきわめて浅い状態であったため，急性緑内障発作と考えられた。点眼・点滴処置を施行したが眼圧は下降せず，重症の脳性麻痺により日常生活の活動性がないことから，即日両眼の経毛様体扁平部水晶体吸引術を施行した。術後眼圧は両眼10mmHg前後で安定している。

結論：ROP治療眼の浅前房と厚い水晶体という前眼部形態異常と，脳萎縮による眼窩骨の発育不全がさらに眼軸の伸長を抑制し，急性緑内障発作を発生したと推論した。

Abstract　Purpose：Herein, we report an acute glaucoma attack occurring in a case of retinopathy of prematurity（ROP）treated eye without proliferative membrane. The treatment had included retinal photocoagulation, and an intravitreal injection of anti-vascular endothelial growth factor.

Case：We present the case of a 7-year-old girl born at 25 weeks and 2 days gestation, weighing 483 grams. After treatment for aggressive ROP（AROP）, the retinopathy had stabilized, but due to global brain atrophy, there was under development in the cranial and orbital bones. The left eye exhibited sudden conjunctival congestion and edema, with an intraocular pressure of 41 mmHg and both eyes displaying an extremely shallow anterior chamber, leading to a suspected acute glaucoma attack. Despite eye drops and other treatments, the intraocular pressure did not reduce. Owing to severe cerebral palsy and a lack of functional daily activities, the patient underwent bilateral lensectomy from the flat ciliary body on the same day. Post-surgery, the intraocular pressure stabilized around 10 mmHg in both eyes.

Conclusion：We deduced that the anterior segment abnormality of shallow anterior chambers and thick lenses in the eyes treated for ROP, along with cranial bone underdevelopment due to brain atrophy, further hindered ocular axis development, leading to the occurrence of acute glaucoma.