サイズ不適合ICL挿入術後に閉塞隅角緑内障および毛様体解離をきたしICL抜去に至った1例

A case of angle-closure glaucoma and cyclodialysis caused by a size-mismatched implantable Collamer lens leading to lens extraction

要約　目的：サイズ不適合有水晶体眼内レンズ（ICL）挿入により閉塞隅角緑内障（ACG）をきたし，ICL摘出に至った症例を報告する。

症例：38歳，男性。30歳時に両眼ICL挿入術を施行したが，両眼霧視を主訴に受診した。初診時，視力 右（1.5），左（1.5），眼圧 右37mmHg，左40mmHg，両眼円錐角膜と閉塞隅角を認めた。vaultは右1.52角膜厚（CT），左1.31CT，ハンフリー中心30-2プログラムによる視野検査で緑内障による視野障害を認め，MD値は右−7.64dB，左−21.37dBであった。ラタノプロスト，ドルゾラミド塩酸塩・チモロールマレイン塩酸塩，1％ピロカルピン塩酸塩，アセタゾラミド内服を開始し眼圧は下降したが，近視化と浅前房の進行，毛様体解離を認めた。薬剤を中止すると眼圧が再上昇し，ICL摘出術を施行した。摘出したICLサイズは13.7mmであり，前眼部光干渉断層計による適切なICLサイズは12.1mmであった。術前と術後1か月の前房深度（ACD）（mm），線維柱帯虹彩面積（TISA）500（mm²）は右眼：1.71 → 2.75，0.0535 → 0.090，左眼：1.83 → 2.68，0.0475 → 0.082であった。術後，眼圧は下降し，毛様体解離は術後1か月で消失した。

結論：サイズ不適合ICL挿入後にACGを引き起こす症例があり，術前後の隅角形状の評価と術後長期の経過観察が重要である。

Abstract　Purpose：We report a case of angle-closure glaucoma（ACG） caused by a size-mismatched ICL, leading to ICL extraction.

Case：A 38-year-old male presented with bilateral blurry vision. Previous medical history was bilateral ICL implantation performed at another institution at the age of 30 years. His vision was preserved；however, ocular hypertension was noted in both eyes（RV＝（1.5）, LV＝（1.5）, RT＝37 mmHg, and LT＝40 mmHg）. The patient was diagnosed with bilateral keratoconus and angle-closure glaucoma. The vault measurements were 1.52 CT on the right and 1.31 CT on the left. On campimetry, HFA MD values were −7.64 dB on the right and −21.37 dB on the left. Treatment was initiated with latanoprost, dorzolamide hydrochloride/timolol maleate, 1％ pilocarpine hydrochloride in both eyes, and oral acetazolamide. Three days later, the IOP decreased. However, myopia progression, shallowing of the anterior chamber, and ciliary detachment were also observed. The intraocular pressure increased again, and bilateral ICL extractions were performed. The size of the extracted ICLs was 13.7 mm in both eyes, whereas the appropriate ICL size calculated using AS-OCT was 12.1 mm. Changes in preoperative and 1-month postoperative ACD（mm）, TISA 500（mm²） were as follows：1.71 to 2.75, 0.0535 to 0.090 in the right eye, and：1.83 to 2.68, 0.0475 to 0.082 in the left eye. Postoperative intraocular pressure decreased, and ciliary detachment resolved at one month postoperatively.

Conclusion：Size-mismatched ICL caused ACG. Pre- and postoperative evaluation of angle geometry, as well as long-term postoperative follow-up, are considered essential for optimal outcomes.