閉塞隅角緑内障を合併した後部強膜炎

A case of closed angle glaucoma with posterior scleritis

　80歳の女性が，右眼に疼痛と眼瞼浮腫を伴った急性閉塞隅角緑内障を発症した。前房は浅く隅角は全周で閉塞していたため，レーザー虹彩切開術を行ったが無効で，術後に著明な結膜浮腫と激しい眼窩深部痛が生じた。眼底には脈絡膜剥離がみられた。超音波検査では眼球後壁の肥厚がみられたが，CTでは眼球後壁の肥厚はわずかであった。MRIでは強膜の肥厚はみられず，脈絡膜とテノン嚢の肥厚がみられた。超音波検査における眼球後壁の肥厚像は本症例では強膜でなく脈絡膜に起因すると考えられた。緑内障発作の1週間後から症状は自然に軽快しはじめた。

A 80-year-old woman presented with edema in her right eyelid with ipsilateral facial pain. She was ophthalmologically intact except for nuclear cataract. Her complaints subsided one week later. Four weeks later, she had another episode of right ocular pain and eyelid edema. The intraocular pressure (TOP) was 38 mmHg. The right eye was diagnosed as closed angle glaucoma. Laser iridotomy resulted in still elevated TOP, chemosis and ocular pain. Funduscopy showed choroidal detachment. Ultrasonography and computed tomography showed thickening of the posterior coat of the right eye. Magnetic resonance imaging showed normal posterior sclera and thickening of the choroid and Tenon's capsule. The ultrasonographically observed thickening of the posterior coat thus appeared to be mainly located in the choroid. Spontaneous resolution set in one week after the glaucomatous attack.