頸部内頸動脈ステント留置直後から虚血性眼症状が改善した頸部内頸動脈狭窄症の1例

Immediate Improvement of Ischemic Oculopathy after Stenting for Internal Carotid Artery Stenosis

今回筆者らは，頸部内頸動脈狭窄症による眼虚血症候群に対して頸動脈ステント留置術を施行し，直後より急速に視力の改善した1例を経験した。症例は76歳女性で，徐々に左眼の視力低下を自覚し，左虹彩に新生血管を認めた。頸部頸動脈超音波で内頸動脈の狭窄を認め，負荷試験で盗血現象を認めたため，頸動脈ステント留置術を施行した。血行再建後の視力改善には数カ月かかるとされているが，今回の症例では直後から急速な視力の改善を認めた。この原因については，ステント留置に伴い，眼動脈への血液の逆流が順行性に改善したことが考えられた。

Abstract

Ocular ischemic syndrome occurs when ocular circulation becomes impaired owing to various causes, leading to disturbances in the visual function. It ultimately progresses to neovascular glaucoma and loss of sight. Therefore, the early diagnosis and treatment of patients with ocular ischemic syndrome has a major effect on their visual prognosis. Herein, we describe a patient who complained of decreased vision in one eye. The patient was subsequently diagnosed with internal carotid artery stenosis because of neovascularity (rubeosis iridis) around the iris in the anterior eye. The vision of the patient improved immediately after carotid artery stenting. A review of the literature indicated that the visual improvement could be attributed to the reversal of retrograde blood flow, caused by internal carotid artery stenosis, to normal levels; the resolution of rubeosis in the anterior eye; and improvement in the visual field constriction.

(Received February 21, 2014; Accepted May 12, 2014; Published December 1, 2014)