眼虚血症候群における虹彩ルベオーシスの発生と予防

Development and prevention of rubeosis iridis in ocular ischemic syndrome

　経過中に虹彩ルベオーシスが発生した眼虚血症候群7例7眼の臨床像を解析した。症例は53歳から67歳で，全例男性である。罹患眼の初診時視力は全例0.4以上で，3mmHg以上の眼圧の左右差が3例にあった。頸動脈の高度狭窄が3例，閉塞が4例にあった。虹彩ルベオーシスは初診後2か月から2年後に発生した。眼底には1例を除いて低循環による網膜症があった。眼動脈カラードップラー検査で4眼に逆流現象があった。経過中に汎網膜光凝固を2眼に行い，1眼に網膜中心動脈閉塞症が発症した。低循環網膜症，眼圧の左右差，眼動脈の逆流現象が虹彩ルベオーシス発症の危険因子であり，その予防には光凝固のみでは不十分であることが結論される。

We reviewed 7 eyes of 7 patients which developed rubeosis iridis during the course of observation for ocular ischemic syndrome. All the cases were males aged from 53 to 67 years. At the initial examination, all the eyes had visual acuity of 0.4 or greater. The carotid artery was stenosed in 3 cases and was occluded in 4 cases. Three cases showed a difference of intraocular pressure (IOP) by 3mmHg or more between both eyes. Rubeosis iridis became manifest 2 months to 2 years after initial visit. Hypoperfusion retinopathy was present in 6 eyes. Color doppler imaging showed reversal of blood flow in the ophthalmic artery in 4 cases. Panretinal photocoagulation was performed in 2 eyes, one of which developed central retinal artery occlusion later. These cases illustrate that rubeosis iridis is prone to develop in the presence of hypoperfusion retinopathy, IOP difference between both eyes, and reversed blood flow in the ophthalmic artery. Rubeosis iridis developed even after panretinal photocoagulation.