透析時の眼圧上昇に高浸透圧薬と高ナトリウム透析が有効であった血管新生緑内障の1例

Infusion of hyperosmotic solution during hemodialysis with high-concentration sodium was effective in a case of neovascular glaucoma with ocular hypertension after hemodialysis

要約　目的：血液透析直後に生じる眼圧上昇に，透析液の調整が奏効した血管新生緑内障の症例の報告。症例：53歳男性が22年前に2型糖尿病と診断された。12年前に両眼の糖尿病網膜症に対し汎網膜光凝固を受け，8年前から腎症に対し血液透析を受けている。11年前に右眼に硝子体トリプル手術が行われた。18か月前に右眼に血管新生緑内障が生じ，濾過手術を複数回受けた。所見：矯正視力は右0.3，左1.0で，眼圧は透析直後では38mmHg，非透析日には12mmHgと動揺を繰り返した。左眼圧は18mmHgに安定していた。透析に高ナトリウム濃度液を用い，透析中の高浸透圧薬の点滴で透析直後の高眼圧はなくなり，最終的には高ナトリウム濃度のみで右眼圧が18mmHgに安定し，高浸透圧薬の点滴後の眼圧再上昇もなくなった。結論：透析条件を調整することで透析直後の眼圧上昇が抑制できた。

Abstract.　Purpose：To report a case of neovascular glaucoma who was treated for elevation of intraocular pressure（IOP）immediately after hemodialysis. Case：A 53-year-old male had been diagnosed with type 2 diabetes mellitus 22 years before and received panretinal photocoagulation for diabetic retinopathy 12 years before. He has been under hemodialysis since 8 years before. The right eye received multiple sessions of filtrating surgery for neovascular glaucoma. Findings：His corrected visual acuity was 0.3 right and 1.0 left. IOP in the right eye fluctuated between 38mmHg immediately after hemodialysis and 12mmHg the following day. IOP in the left eye was stable at 18mmHg. Infusion of hyperosmotic agent during hemodialysis with high-concentration sodium induced control of IOP. Eventually, IOP in the right eye stabilized at 18mmHg without infusion. Conclusion：Rise in IOP immediately after hemodialysis was prevented by using hyperosmotic solutions for hemodialysis.