両側内頸動脈閉塞症に起因した眼虚血性症候群の1例

A case of ocular ischemic syndrome as complication of bilateral internal carotid occlusion

　螢光眼底検査，oculo cerebro vas-culometry （以下OCVM検査と略す），digitalsubtraction angiography （以下DSA検査と略す）などにより，慢性の両側内頸動脈閉塞症と診断された1症例について，文献的考察を含めて紹介した．

　症例　は83歳男性で，左眼の突然の視力低下を主訴とし，経過観察中に右眼にも一過性の黒内障発作様症状をきたした．

　眼底所見として，左眼は黄斑部を含めた後極部網膜に浮腫状混濁を，右眼は中等度の動脈硬化を呈していた．

　螢光眼底所見としては，両眼の腕-脈絡膜循環時間・腕-網膜循環時間，ならびに網膜内循環時間などが遅延しており，特に左眼で著しかった．

　網膜中心動脈圧は両眼とも高血圧を示し，特に拡張期血圧が高値を示した．

　DSA検査で両側内頸動脈閉塞症と確認できたにもかかわらず，OCVM検査に異常を認めなかったことなどから，慢性の両側内頸動脈閉塞症と診断し，網膜血管抵抗の上昇に伴う，広義の眼虚血性症候群の一種と考えた．

A 83-year-old male noticed abrupt and lasting visual loss in his left eye. A similar but fleeting amurotic attack occurred in the right eye 20 days later. Funduscopically, we noticed edematous opa-city of the macula in the left eye and arteriosclero-sis of a moderate degree in the right.

Fluorescein angiography showed grossly pro-longed values for arm-to-retina, arm-to-choroid and intraretinal circulation times in both eyes. Theprolongation was more remarkable in the left than in the right eye. The blood pressure in central retinal arteries and in ophthalmic arteries showed elevated values. Carotid angiography showed bilat-eral occlusion of internal carotid at the site of bifurcation.

The present case was interpreted as an instance of ocular ischemic syndrome triggered apparently by an increase in retinal vascular resistance.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(4) : 387-391, 1987