血液透析の時間短縮を契機にスパイク状の高眼圧を生じた1例

A case with spikes of intraocular pressure following hemodialysis

要約　目的：血液透析の時間短縮を契機にスパイク状の高眼圧を生じた1例を報告する。

症例：20歳時に急性腎不全を発症し，以後血液透析中の42歳男性。半年前から頻回に左眼霧視を自覚していた。

所見：眼圧は右13mmHg，左53mmHg。右眼は開放隅角，左眼に全周の周辺虹彩前癒着を認めた。左眼にマイトマイシンC併用線維柱帯切除術を施行し，術後眼圧は10〜18mmHgと低下した。右眼にも血液透析後のスパイク状の眼圧上昇を生じるようになったが，高浸透圧補液併用の血液透析および血液透析時間の補正を依頼したのち，眼圧は正常値内に維持された。

結論：緑内障症例では，血液透析後のスパイク状の眼圧上昇に注意すべきである。また，血液透析時間にも留意する必要がある。

Abstract　Purpose: To report a case who showed spikes of intraocular pressure（IOP）elevation following hemodialysis.

Case: A 42-year-old man was referred to us for blurring of vision in the left eye. He had had proteinuria since childhood. He had developed acute renal failure at the age of 20 years. He had been receiving hemodialysis ever since. He had noticed blurring in the left eye after each session of hemodialysis since 4 years before. He had been receiving topical medication for glaucoma in the left eye.

Findings and Clinical Course: Corrected visual acuity was 1.0 in either eye. The IOP was 13 mmHg right and 53 mmHg left. The left eye showed peripheral anterior synechia in the whole circumference. IOP in the left eye decreased below 18 mmHg after trabeculectomy with mitomycin C. The right eye started to show IOP spike after each session of hemodialysis. IOP was kept within normal range after start of hemodialysis using hypertonic solution and prolonged duration of hemodialysis.

Conclusion: The present case illustrates that spikes of IOP elevation may occur after hemodialysis and that due attention is needed regarding duration of hemodialysis.