続発閉塞隅角緑内障をきたしたぶどう膜悪性黒色腫の2症例

Two cases of uveal malignant melanoma with secondary angle closure glaucoma

要約　目的：ぶどう膜悪性黒色腫から続発閉塞隅角緑内障をきたした2症例の報告。

症例：症例1は75歳の男性。右眼毛様体腫瘍で精査予定であったが，腫瘍からの突然の大量出血と眼圧上昇を認めた。症例2は71歳の女性。左眼眼痛が出現し救急搬送され，腫瘍からの大量出血と眼圧上昇を認めた。両症例とも画像診断のうえ，進展したぶどう膜悪性黒色腫と診断し，眼球摘出を行った。摘出眼球の病理所見から，2例とも腫瘍の急速な発育によって，腫瘍壊死と大量出血を生じ，眼内ボリュームが急速に増大したため，水晶体の前方移動によって急性閉塞隅角緑内障をきたしたと思われた。

結論：ぶどう膜悪性黒色腫は急速な腫瘍増大と壊死・出血によって，急性閉塞隅角緑内障を惹起する可能性がある。

Abstract　Purpose：To report two cases of secondary angle closure glaucoma from uveal malignant melanoma.

Cases：Case 1 was a 75-year-old male. Although right eye was planned to be examined by the large ciliary tumor, massive intraocular hemorrhage and elevation of intraocular pressure occurred. Case 2 was a 71-year-old female. Ocular pain of the left eye suddenly appeared and the patient was transported to the emergency department. Massive hemorrhage from the tumor and elevation of intraocular pressure were observed. From clinical findings, both cases were diagnosed as uveal malignant melanoma and enucleation of the eye balls were performed. Histopathologically, tumor necrosis and massive hemorrhage were observed. It was suggested that acute angle-closure glaucoma occurred due to rapid increase in intraocular tumor volume which caused compression anterior movement of the lens.

Conclusion：Uveal malignant melanoma might cause acute angle-closure glaucoma due to rapid development of the tumor with tumor necrosis and massive hemorrhage.