眼虚血症候群を示さなかった眼動脈閉塞の1例

A case of ophthalmic artery occlusion without manifestation of ocular ischemic syndrome

　48歳男性が5分間の左眼暗黒感を自覚し，その2週後に受診した。麻痺，構語障害，めまいなどの脳神経症状はなかった。視力は正常で，眼球運動や眼底には異常所見はなかった。網膜中心動脈圧は正常で左右差はなく，腕—網膜と網膜内の循環時間に遅延ないし左右差はなかった。脳血管撮影で左眼動脈は起始部から造影されなかった。眼窩ドプラ検査で左眼動脈の中枢側は眼窩内では描出されず，血液は外頸部動脈の涙腺動脈を経由して逆行性に流れていた。片側の眼動脈の完全閉塞があるにもかかわらず，眼虚血症候群が生じなかった例である。

A 48-year-old male was referred to us two weeks after amaurosis fugax in his left eye two weeks before. Signs of cerebral lesions, including palsy, apraxia or vertigo, were consistently absent. He had normal visual acuity and ocular motility. Funduscopy showed no abnormal findings. The central retinal arterial pressure was normal with no difference between both eyes. There was no abnormal values in arm-to-retina or intraretinal circulation times. Cerebral angiography failed to show the left ophthalmic artery throughout. Color doppler test showed absence of blood flow in the proximal intraorbital portion of left ophthalmic artery, as the blood was retrogradely supplied from the facial artery through lacrimal artery into the ophthalmic artery. This case illustrates that ocular ischemic syndrome may be absent in spite of complete unilateral occlusion of ophthalmic artery.