一過性黒内障発作を伴った大動脈炎症候群の1例 頸動脈再建術と視機能の経過

Reconstruction of carotids improved visual functions in a case of aortitis syndrome with amurosis fugax

　一過性黒内障発作を契機に大動脈炎症候群が発見された12歳女児例を経験した．本症例は初診時眼底に網膜静脈の拡張蛇行，小血管瘤，綿花様白斑，sludge現象が認められ，全身所見とあわせて大動脈炎症候群と診断された．ステロイド剤を中心とした抗炎症剤で治療が開始され一時炎症反応の改善が見られたが，その後眼底所見の増悪とともに視機能障害が進行し，脳虚血発作も頻発するようになった．大動脈血管撮影にて両側総頸動脈と左椎骨動脈の閉塞が認められたため，上行大動脈と右総頸動脈及び上行大動脈と左鎖骨下動脈の人工血管吻合術，右椎骨動脈のパッチ拡大術が施行された．術後，視機能はほぼ正常に復し，眼底所見も著明に改善した．

　本症例の経過より，著明な眼循環障害を伴い内科的治療に抵抗する大動脈炎症候群には，視機能の保持のためにも積極的に血行再建術を施行すべきことを強調した．

A 12-year-old girl presented with repeated attacks of amurosis fugax of recent onset. Fundus-copy showed varicose retinal veins, microaneur-ysms, cotton-wool patches and sludge phenomenon bilaterally. Further systemic findings led to the diagnosis of aortitis syndrome. Systemic corticos-teroids was futile in preventing exacerbation of fundus lesions or frequent cerebral ischemicattacks. Angiography showed occlusion of both common carotids and left vertebral artery.

Vascular surgery was undertaken to bypass the occluded vessels. Artificial vessel was implanted between the ascending aorta and the right common carotid, and also between the ascending aorta and the left subclavicular artery. An enlargement of the right vertebral artery was also performed. After surgery, the visual functions returned to normal levels, associated with remarkable improvements in fundus findings.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(17) : 767-770, 1988