眼虚血症候群による血管新生緑内障の検討

Neovascular glaucoma secondary to ocular ischemic syndrome

　眼虚血症候群による血管新生緑内障6例の臨床像と転帰を検索した。男性5例，女性1例で，年齢は41～80歳（平均70歳）であった。基礎疾患として，高血圧と高脂血症が各5例，糖尿病と脳梗塞が各3例，緑内障が2例にあった。全例で腕-網膜時間が著明に延長していた。全例に汎網膜光凝固と毛様体冷凍術を行い，線維柱帯切除術，ウロキナーゼ大量療法，脳血管バイパス術を各1例に行った。2例で新生血管が消退し，線維柱帯切除術で眼圧が下降した。4例で新生血管が消退せず，うち1例ではバイパス術でも眼循環が改善せず失明に至った。眼虚血症候群による血管新生緑内障は予後不良であり，危険因子がある患者ではその発症の可能性を考えて各種検査を行う必要がある。

　We reviewed 6 cases of ocular ischemic syndrome with neovascular glaucoma. The series comprised 5males and 1 female. They were aged from 41 to 80 years,average 70 years. Associated diseases comprised systemic hypertension 5 cases,hyperlipemia 5 cases,diabetes mellitus 3 cases,cerebral infarction 3 cases,and glaucoma 2 cases. All the cases prolonged arm-to-retina circulation time. All the cases were treated by panretinal photocoagulation and cyclocryopexy. Trabeculectomy,urokinase infusion,or carotid bypass surgery was performed for one case each. Rubeosis iridis disappeard in 2 cases,followed by control of intraocular pressure after trabeculectomy. Rubeosis iridis persisted in the other 4 eyes. One eye became blind in spite of carotid bypass surgery. The findings show that ocular ischemic syndrome has a poor prognosis when associated with neovascular glaucoma. We advocate early diagnosis of ocular ischemic syndrome,particularly in high-risk patients.