血液透析時の眼圧上昇に血液濾過が有効であった1例

Hemofiltration was effective for ocular hypertension in a case receiving hemodialysis

要約　目的：血液透析時に眼痛があり，透析後に眼圧が顕著に上昇する症例に，血液濾過への変更が奏効した報告。症例：57歳の男性が血液透析中に生じる右眼の疼痛で受診した。32歳から糖尿病があり，39歳から囊胞腎による慢性腎不全で血液透析を開始し，42歳から拡張性心筋症，49歳の時に小脳出血があった。母，兄，姉が囊胞腎による腎不全で死亡している。所見と経過：透析前は無症状で，矯正視力は両眼とも1.2であり，眼圧は右20mmHg，左15mmHgであった。眼底に糖尿病網膜症はなかった。眼圧は透析直後に右30mmHg，左21mmHgに上昇した。グリセオール200mlを点滴で併用した。透析直後の眼圧上昇には変化がなかった。初診から3か月後に血液透析を血液濾過に変更した。血液浄化前後の眼圧は14～20mmHgの範囲におさまるようになり，眼痛はなくなった。初診から20か月後に不帰の転帰をとった。結論：血液透析時の眼圧上昇に，血液濾過への変更が奏効した。

Abstract.　Purpose：To report a case who showed ocular pain and elevated intraocular pressure（IOP）during hemodialysis that responded after switching to hemofiltration. Case：A 57-year-old male presented with pain in the right eye during each session of hemodialysis. He had been diagnosed with diabetes mellitus at the age of 32 years, and started receiving hemodialysis for kidney cyst with renal failure since the age of 39 years. His mother, brother and sister had died due to kidney cyst with renal failure. Findings：He was doing well before hemodialysis with corrected visual acuity of 1.2 in either eye and IOP of 20 mmHg in the right eye and 15 mmHg in the left. Both eyes were free of diabetic retinopathy. IOP rose to 30 mmHg in the right eye and 21 mmHg in the left immediately after hemodialysis. Peroral intake of 200 ml glycerine failed to prevent IOP elevation during and after hemodialysis. Hemodialysis was switched to hemofiltration 3 months after his initial visit. IOP remained between 14 and 20 mmHg with no ocular pain after switching. Conclusion：Switching to hemofiltration was effective for ocular hypertension during hemodialysis.