8歳発症の原発開放隅角緑内障例

Primary open-angle glaucoma in an eight-year-old child

（P−2-59）　8歳男児が近視で眼科を受診し，乳頭陥凹の拡大が左眼に発見された。喘息とアトピー皮膚炎があり，ステロイド軟膏を使用していたが顔面には塗布していない。眼圧は右18mmHg，左19mmHgであった。左眼に鼻側下法の視野欠損があり，緑内障が疑われた。左眼圧は4か月後に22mmHgになった。点眼治療を行ったが眼圧は30mmHg台に上昇し，当科を紹介された。緑内障として点眼治療を追加したが，左眼の視野欠損が進行し，その2か月後に線維柱帯切除術を行った。以後7か月間，薬物なしで左眼圧は10mmHg台に維持され，視野欠損の進行もない。患児とその父に，緑内障の遺伝子ミオシリンの変異はなかった。このような若年でも原発開放隅角緑内障が起こりうることを示す症例である。

An 8-year-old boy sought medical advice for myopia. Enlarged cupping of the disc was detected in his left eye. He had been suffering from asthma and atopic dermatitis. Corticosteroid ointment had been applied to the body surface except the facial area. His intraocular pressure (TOP) was 18mmHg right and 19 mmHg left. The left eye showed visual field defect in the nasal temporal quadrant. The IOP in the left eye rose to 22 mmHg 4 months later and eventually to 30 mmHg in spite of topical antiglaucomatous medication. He was referred to us and received intensive topical treat for glaucoma. Progression of left visual field defect necessitated mitomycin C-assisted trabeculectomy 2 months later. The TOP in the left eye has been controlled below 20 mmHg with no changes in the visual field during the following 7 months. Gene analysis in the patient and his father gave negative findings regarding myocilin gene mutation. This case illustrates that primary open-angle glaucoma may manifest at the age of 8 years.