点眼時間変更により眼圧下降を得た不均衡症候群の1例

Acute ocular hypertension following hemodialysis treated by shift in timing of topical medication

要約　目的：点眼時間の変更で眼圧下降が得られた不均衡症候群の1例の報告。

症例：開放隅角緑内障がある65歳男性が副腎腫瘍の摘出を受け，23年前から週3回の午前中に血液透析を受けていた。透析の直後に左眼の霧視と疼痛が生じて受診した。眼圧はそれまで右22mmHg，左15mmHgで安定していた。

所見と経過：矯正視力は左右眼とも1.0で，眼圧は右28mmHg，左55mmHgであった。その2日後にも同様な発作があった。透析に付随した不均衡症候群と判断し，緑内障に対する点眼を透析直後に変更した。それ以降，透析日の左眼圧は10mmHgで安定した。

結論：房水量が増加する透析直後に点眼をすることで，眼圧下降が得られた。不均衡症候群での眼圧上昇は，透析中の血漿浸透圧勾配により血液から眼内に水の流入が生じる可能性がある。

Abstract　Purpose: To report a case who developed acute ocular hypertension following hemodialysis and who was treated by shift in timing of topical medication for glaucoma.

Case: A 65-year-old male presented with pain and blurring in the left eye following hemodialysis the same day. He had been receiving hemodialysis 3 times a week since 23 years before. He had been diagnosed with primary open-angle glaucoma 5 years before and been treated by topical medication. His intraocular pressure（IOP）had been maintained at about 22 mmHg right and 15 mmHg left.

Findings and Clinical Course: Corrected visual acuity was 1.0 in either eye. IOP was 28 mmHg in the right eye and 55 mmHg in the left. He developed similar episode after hemodialysis two days later. Under the diagnosis of disequilibrium syndrome, he was instructed to apply topical medication for glaucoma immediately after hemodialysis. His IOP has been maintained at about 10 mmHg thereafter.

Conclusion: Ocular hypertension following hemodialysis was prevented by applying topical medication immediately after hemodialysis. This case suggests that elevation of IOP following hemodialysis may be due to shift of fluid from the blood to the eye.