内頸動脈閉塞に虹彩毛様体炎を合併した血管新生緑内障の1例

Neovascular glaucoma and iridocyclitis in a case of unilateral internal carotid artery occlusion

要約　目的：血管新生緑内障と虹彩毛様体炎が発症した内頸動脈閉塞症の症例の報告。症例：64歳の男性が両眼の眼圧上昇と右眼の前房出血で紹介され受診した。所見：矯正視力は右0.5，左0.6で，眼圧は右44mmHg，左55mmHgであった。両眼に前房内細胞があり，右眼に虹彩と隅角のルベオーシス，左眼に角膜後面沈着物があった。両眼とも糖尿病網膜症の所見はなかった。蛍光眼底造影による腕網膜循環時間が延長していた。脳外科の検査で右内頸動脈が99％閉塞していた。薬物治療で左右眼とも眼圧は低下した。右眼の隅角は2か月後に全周が癒着閉塞し，眼圧は大幅に上下し，2年の間に視野欠損が進行した。結論：本症例では内頸動脈閉塞により同側の眼虚血状態が生じ，続発した虹彩毛様体炎の経過とともに眼循環と房水産生が変化して，眼圧が大幅に変動したと考えられる。

Abstract.　Purpose：To report a case of neovascular glaucoma and iridocyclitis secondary to unilateral occlusion of internal carotid artery. Case：A 64-year-old male was referred to us for hyphema in right eye and elevated intraocular pressure（IOP）in both eyes. Findings：Corrected visual acuity was 0.5 right and 0.6 left. IOP was 44 mmHg right and 55 mmHg left. Both eyes showed cells in the aqueous. The right eye showed rubeosis in the iris and chamber angle. The left eye showed keratic precipitates. Findings of diabetic retinopathy were absent. Fluorescein angiography showed protracted arm-to-retina circulation time. Carotid angiography showed occlusion of right internal carotid artery（ICA）. IOP was initially controlled by topical and systemic medication. Total peripheral anterior synechia（PAS）developed in the right eye 2 months later followed by fluctuations of IOP. Visual field became defective 2 years later. Conclusion：ICA occlusion would have resulted in ischemia in the ipsilateral eye. IOP fluctuations may have been due to iridocyclitis with changes in ocular circulation and aqueous production secondary to ocular ischemia.