閉塞隅角緑内障の発作1年後に水晶体亜脱臼が生じた1例

A case of lens subluxation one year after angle closure glaucoma

　69歳女性の右眼に急性閉塞隅角緑内障の発作が起こった。全幅虹彩切除では浅前房が改善せず，眼圧も下降しなかった。水晶体亜脱臼と膨隆白内障の所見がなく，悪性緑内障が疑われた。散瞳薬の5日間の点眼で発作は寛解せず，core vitrectomyと前房形成術も無効であった。さらにアトロピンの点眼継続で眼圧は正常化した。1年後に，水晶体亜脱臼と続発閉塞隅角緑内障が発症した。水晶体嚢内摘出と前部硝子体切除で治癒した。最初の発作は特発性の悪性緑内障であり，水晶体の前方移動が原因と考えられた。

A 65-year-old female developed acute angle closure glaucoma in her right eye. Total iridectomy failed to deepen the anterior chamber or normalize the intraocular pressure. There was no phakodonesis nor intumescent cataract. The findings were suggestive of malignant glaucoma. Topical instillation of atropine failed to relieve the attack. Subsequent core vitrectomy and surgical deepening of anterior chamber were ineffective. Further topical instillation of atropine induced normalization of intraocular pressure. She returned one year later with another attack of angle closure glaucoma with lens subluxation. Intracapsular lens extraction and anterior vitrectomy led to clinical cure. The initial attack appeared to be malignant glaucoma induced by anterior displace-ment of the lens.