浅側頭動脈—中大脳動脈吻合術が有効であった眼虚血症候群の1例

Anastomosis between superficial temporal and middle cerebral artery was effective in a case of ocular ischemic syndrome

（P3-2-32）　脳梗塞と左眼視力低下で発症した虚血性網膜症に対して，浅側頭動脈—中大脳動脈吻合術（STA—MCA吻合術），椎骨動脈総頸動脈転移術を行い視力，眼底所見の改善を得た1例を経験した。患者は51歳男性，既往歴には糖尿病と胃潰瘍があり，術前，左眼に網膜浮腫と綿花状白斑がみられた。螢光眼底造影では腕—網膜循環時間，眼内循環時間ともに遅延しており，頸動脈造影検査で左内頸動脈の完全閉塞と左椎骨動脈は高度に狭窄していた。術前後で左眼の視力は改善し網膜浮腫，綿花状白斑は減少した。術後約1か月で左眼に網膜斑状出血を生じたが徐々に消退し，約5か月後で左右差はなくなった。螢光眼底造影でも網膜動静脈からの螢光色素の漏出は減少し，手術は有効であった。

A 51-year-old male presented with retinal edema with soft exudates in his left eye. He had had diabetes mellitus and gastric ulcer. Fluorescein angiography showed increased arm-to-retina circulation and intraretinal circulation times in the affected eye. Carotid angiography showed occlusion of left internal carotid artery and stenosis of left vertebral artery. He was diagnosed as ocular ischemic syndrome. He underwent anastomosis between superficial temporal and middle cerebral artery and anastomosis between vertebral and common carotid artery in the affected side. Following surgery, the visual acuity improved from 0.6 to 1.0 associated with disappearance of retinal edema and soft exudates. At one month after surgery, blot hemorrhages appeared in the left fundus but disappeared 5 months later. This case illustrates the efficacy of anastomosis surgery for ocular ischemic syndrome.