EX-PRESS®併用濾過手術後に強膜融解およびぶどう膜露出を認めた1例

A case of scleromalacia with uvea exposure after trabeculectomy using the EX-PRESS® shunt

要約　背景：EX-PRESS^®併用濾過手術は，緑内障濾過手術のなかで低侵襲であるといわれている。

目的：強膜炎に続発した難治性緑内障患者に対し，EX-PRESS^®併用濾過手術を施行，手術4年後に強膜融解およびぶどう膜露出を認めた1例の報告。

症例：75歳，女性。強膜炎に続発した緑内障で当院に紹介された。抗緑内障点眼に抵抗性を示したため，右眼に対し0.02％マイトマイシンCおよびEX-PRESS^®併用濾過手術を施行。術翌日より結膜縫合部に房水漏出を認めたため，術8日後に結膜縫合を追加し，房水漏出は改善された。レーザー切糸後も濾過胞形成不良のため術68日後にニードリングを施行。その後は濾過胞形成良好で，右眼圧10mmHg前後と経過良好であった。しかし4年後，強膜フラップの融解およびぶどう膜露出を認めたため，同部位に対して左眼耳側結膜からの遊離弁を移植した。術後遊離弁の生着は良好で，感染もなく眼圧経過も良好である。

結論：低侵襲といわれているEX-PRESS^®併用濾過手術でも長期経過で強膜融解やぶどう膜露出などの晩期合併症が起こる可能性がある。

Abstract　Background：EX-PRESS^® shunt is regarded as a less invasive infiltration surgery for glaucoma than conventional filtration methods.

Purpose：To report a case who developed scleromalacia with uveal exposure after EX-PRESS^® shunt surgery.

Case：A 75-year-old female was referred to us for glaucoma secondary to scleritis in the right eye. She had a history of rheumatic arthritis.

Findings and Clinical Course：Intraocular pressure（IOP）was 36 mmHg in the right eye and 13 mmHg in the left. As IOP in the right eye failed to respond to topical medications, she received EX-PRESS^® shunt surgery with 0.02％ mitomycin C. A conjunctival suture was added 8 days later for leakage at the site of conjunctival wound. Laser suturelysis with needling was performed 68 days after surgery. The filtering bleb was well maintained with controlled IOP. She was referred to us again, 4 years later, as the right eye developed scleromalacia with uveal exposure. The site was covered by a conjunctival flap from the fellow eye. She has been doing well for 4 months until present.

Conclusion：This case illustrates that EX-PRESS^® shunt surgery may be followed by late complications including scleromalacia with uveal exposure.