白内障手術待機中に視力低下の増悪を自覚し術後に悪性リンパ腫による眼窩先端症候群が判明した1例

A case of orbital apex syndrome due to malignant lymphoma diagnosed after cataract surgery, who complained exacerbation of vision loss

要約　目的：白内障手術待機中に視力低下の増悪を自覚し，白内障手術後にびまん性大細胞性B細胞リンパ腫による眼窩先端症候群が判明した1例を経験したので報告する。

症例：79歳，男性。右眼の視力低下を自覚して前医を受診。右（0.8）。白内障の診断で手術予約されていた。手術待機中にさらに視力が低下し（0.5）となり再診したが，予定通り白内障手術を施行された。手術翌日の診察で（0.07），術後炎症は軽微，右眼の眼球突出と全方向への眼球運動障害を認めた。頭部CT検査で副鼻腔内に充満する粘膜病変と右視神経腫大を認め，耳鼻科との連携を含めた治療目的で和歌山県立医科大学附属病院眼科を紹介され受診となった。動的量的視野検査で右眼は鼻側周辺部に島状の視野が残存するのみであった。副鼻腔粘膜生検の結果からびまん性大細胞性B細胞リンパ腫による眼窩先端症候群と診断され，両側肺門部に転移性病変も認めたため，化学療法（R-CHOP療法6コース）を施行された。経過は良好で右眼の最終視力は（0.1），視野，眼球運動の障害の改善を認めた。

結論：白内障手術待機中に急激な視力低下をきたした際には，白内障の再評価や他疾患の合併を検討する必要がある。

Abstract　Purpose：We report a case of orbital tip syndrome due to diffuse large B-cell lymphoma in a patient whose visual acuity worsened while waiting for cataract surgery.

Case：A 79-year-old male patient presented to another doctor after becoming aware of decreased visual acuity in his right eye. His right eye corrected visual acuity was 0.8, and he was diagnosed with cataract and scheduled for surgery. While awaiting surgery, his visual acuity decreased（corrected visual acuity 0.5）, and the patient revisited the hospital. However, cataract surgery was performed as planned. On the day after surgery, postoperative inflammation was slight, visual acuity was corrected to 0.07, and protruded and omnidirectional oculomotor disorders were observed. Head computed tomography revealed a mucosal lesion filling the paranasal sinuses and swelling of the right optic nerve. A Goldmann visual field test showed that only an island-like visual field remained in the nasal periphery of the right eye. Based on the results of sinus mucosa biopsy, orbital apex syndrome due to diffuse large B-cell lymphoma was diagnosed, and metastatic lesions were also found in the bilateral hilar regions. Therefore, chemotherapy（six courses of R-CHOP therapy）was commended. The course was good, and the final corrected visual acuity in the right eye was 0.1.

Conclusion：When a sudden decrease in visual acuity occurs while waiting for cataract surgery, it is necessary to consider reevaluation of cataract and the potential of other diseases.