高安病での網膜血管床閉塞と動静脈吻合の形成過程

Capillary nonperfusion and arteriovenous shunts in the retina in Takayasu's disease

　過去8年間の高安病患者7症例14眼に螢光眼底造影を行い，網膜血管床が慢性に閉塞に至る過程を検索した．この過程には，動静脈吻合の関係しない毛細血管の特発性の閉塞（14眼）と，動静脈吻合が形成された後に続発する閉塞とがあった．この動静脈吻合には優先血行路（14眼），動静脈交差部での吻合（6眼）の2種類があった．これらの動静脈吻合の形成には，その周囲および末梢の血管床閉塞が先行することを必要としなかった．すなわち形成された動静脈吻合は網膜血管床閉塞を併発するものの，発症に関しては動静脈吻合と網膜血管床閉塞は独立した病態であると結論された．

A series of 14 eyes (7 cases) with Takayasu's dis-ease were evaluated as to the development of retinal capillary nonperfusion in relation to arteriovenous shunts through repeated fluorescein angiography.

Retinal capillary nonperfusion was observed to develop either as a primary or secondary process. In the former, capillary nonperfusion developed spontaneously without accompanied by arteriove-nous shunt formation (14 eyes). In the latter, ca-pillary nonperfusion developed secondary to arterio-venous shunt formation. These shunts were formed through development of preferential circulatory channels (14 eyes) or through communication of vascular lumen at the arteriovenous crossings (6 eyes). Thus, arteriovenous shunts were formed not necessarily preceded by capillary nonperfusion in their vicinity or in the more peripheral retina.

Our findings indicate that capillary nonperfusion and artreiovenous shunts, which are character-istic features in Takayasu's disease, may be formed as independent events.