2段階手術を行った小眼球症の閉塞隅角緑内障の1例

A case of nanophthalmos with closed-angle glaucoma treated by sclerectomy and goniosynechialysis

（C1-2-4）　症例は40歳女性。初診時，眼圧は両眼とも68mmHgで，小角膜，浅前房，隅角の全周閉塞を認め，眼軸長は両眼14.2mmで眼底にはuveal effusionが認められた。小眼球症に伴う閉塞隅角緑内障発作と診断し，両眼にレーザー虹彩切開術を施行した。しかし，眼圧が下降しないため，両眼ともまずuveal effusionを軽減する目的で4象限に対して強膜開窓術を行い，その後約2週間目に隅角癒着解離術と超音波白内障手術＋眼内レンズ挿入術を施行した。手術は両眼とも併発症なく行え，さらにレーザー隅角形成術を行い良好な眼圧コントロールを得た。小眼球症の閉塞隅角緑内障の内眼手術には，強膜開窓術を併用する2段階手術が有用と考えられた。

A 40-years-old female was referred to us for intraocular pressure (IOP) of 68 mmHg in either eye. Both eyes showed microcornea, shallow anterior chamber, total angle closure, uveal effusion and axial length of 14.2 mm. She was diagnosed as nanophthalmos with acute closed-angle glaucoma. Both eyes underwent laser iridotomy. Due to still elevated IOP, both eyes underwent sclerectomy in each quadrant to relieve uveal effusion, followed by goniosynechialysis, phacoemulsification-aspiration and intraocular lens implantation. After additional laser gonioplasty, the IOP was brought under control. This case illustrates the efficacy of sclerectomy and goniosynechialysis for nanophthalmos with closed-angle glaucoma.