白内障手術後に幻視の軽快したパーキンソン病の2例

Two Cases of Parkinson's Disease in which Visual Hallucinations Disappeared after Cataract Surgery

　要旨　白内障手術後に幻視の軽快したパーキンソン病の2例を経験した。症例1は72歳女性で，パーキンソン病およびそれに伴うと思われる幻視および音楽性幻聴が存在した。症例2は77歳女性で，パーキンソン病にて通院中に幻視が出現，悪化した。両症例とも薬物調節のみでは幻視を軽快させることは困難であった。しかしながら，重度の両側の白内障に対して手術を行ったところ速やかに幻視は消失した。パーキンソン病における幻視はCharles Bonnet症候群における幻視と類似しており，例えばどちらも薄明かりのもとで起こりやすく，意識清明で開眼時に多いとされる。Charles Bonnet症候群と同様に，パーキンソン病においても幻視の出現に末梢性の視機能障害が関与している可能性があり，手術適応となる白内障を合併したパーキンソン病では，白内障手術によって幻視も改善することが期待される。

　We report two cases of Parkinson's disease in which visual hallucinations disappeared after cataract surgery. Patient 1 was a 72-year-old woman with Parkinson's disease, visual hallucinations and musical hallucinations. Patient 2 was a 77-year-old woman with Parkinson's disease and visual hallucinations. Both patients had severe bilateral cataracts. Though it was difficult to control their visual hallucinations with medication only, cataract surgery made them disappeared quickly. The visual hallucinations of Parkinson's disease are similar to those of Charles Bonnet syndrome. For example, both hallucinations often happen in dim light, at night and when patients are awake with eyes open. Though there have been many reports describing visual hallucinations in Parkinson's disease, there have been few reports discussing the relation between these hallucinations and impaired visual acuity. Similar to the hallucinations of Charles Bonnet syndrome, impaired visual acuity should be related to the visual hallucinations of Parkinson's disease. When Parkinson's disease, visual hallucinations and severe cataract coexist, visual hallucinations may disappear after cataract surgery.

（Received : January 23, 2004）