原発開放隅角緑内障に併発した角膜内皮炎

Corneal endotheliitis in an eye with primary open-angle glaucoma

　10年来の両眼性原発開放隅角緑内障の70歳男子の右眼に角膜内皮炎が発症し，眼圧が急激に上昇した。この角膜内皮炎は，特徴的な臨床所見からヘルペス性角膜内皮炎と考えた。眼圧はステロイドの局所的および全身的投与と，抗ウイルス剤の併用により下降した。原発開放隅角緑内障の経過中に眼圧が急激に上昇した場合は，角膜内皮炎や虹彩炎などの炎症が起こり，続発性緑内障の機序が重なっている可能性があるので注意を要する。

A 70-year-old male was referred to us for acute elevation of intraocular pressure (IOP) in his right eye. He had been under topical medical treatment for primary open-angle glaucoma since 12 years before. The right eye showed sector-shaped corneal edema with mutton-fat precipitates, leading to the diagnosis of corneal endotheliitis with iritis. Systemic and aqueous humor studies were negative for virus infection including herpes simplex. Systemic and topical corticosteroid with intensified antiglaucomatous medication induced disappearance of corneal lesions with well-controlled IOP. Another episode of acute elevation of IOP while under systemic acyclovir was successfully treated by systemic and topical cortico-steroids. The case illustrates that secondary glaucoma due to corneal endotheliitis and iritis is a possibility in primary open-angle glaucoma.