線維柱帯切除術後に脈絡膜剥離をきたした頸動脈海綿静脈洞瘻に伴う続発緑内障の1例

A case of choroidal detachment after trabeculectomy for glaucoma secondary to carotid cavernous sinus fistula

　62歳女性が6年前に複視を自覚し，右外転神経麻痺と診断された。5年前に右眼の充血と眼球突出が生じ，脳血管造影で右海綿静脈洞瘻と診断された。4年前の当科初診時に，右眼に眼圧上昇，眼球突出，外転神経麻痺，充血があった。海綿静脈洞瘻の塞栓術と点眼治療によっても眼圧と緑内障性視野欠損が悪化したので，マイトマイシンC併用で線維柱帯切除術を行った。手術の4日後に脈絡膜全剥離が生じたが，4週後に寛解した。上強膜静脈圧の上昇に続発した緑内障への濾過手術で脈絡膜剥離が起こりうることを本症は示している。

A 62-year-old female developed diplopia and was diagnosed as right abducens palsy 6 years before. Hyperemia and proptosis in the right eye became manifest one year later. Cerebral angiography led to the diagnosis of right carotid cavernous fistula. When seen by us 4 years before, the right eye showed ocular hypertension, proptosis, abducens palsy and hyperemia. Glaucoma with visual field defect progressed in spite of embolization of the fistula and topical eye treatment, necessitating trabeculectomy with mitomycin C application. Total choroidal detachment developed 4 days after surgery and disappeared 4 weeks later. This case illustrates that choroidal detachment is a liability following filtering surgery for glaucoma secondary to elevated episcleral venous pressure.