血液透析中に両眼の眼圧上昇をきたした眼内レンズ縫着後眼の1症例

Bilateral increase in intraocular pressure during hemodialysis in a case with pseudophakia

要約　目的：両眼の眼内レンズ（IOL）縫着術後に，透析中に高眼圧をきたした1症例を報告する。

症例：50歳，男性。生来片腎で34歳時より人工透析を行っている。40歳台前半に両白内障手術，47歳時に右IOL縫着術，48歳時に左IOL縫着術を施行。その頃より徐々に眼圧が高値となり点眼加療していた。6か月前から透析中に左眼の疼痛と霧視を自覚していた。透析終了直後の近医受診時に両眼圧上昇を認め当院紹介となった。

所見：初診時眼圧は右14mmHg，左24mmHg。左IOLは偏心し，虹彩裏面と接触を認めた。両隅角は開放，線維柱帯に色素沈着を認めた。視神経光干渉断層計で両眼に緑内障性視神経変化はなかった。初回透析開始前の眼圧は右12mmHg，左18mmHgであったが，透析後右24mmHg，左50mmHgに上昇した。透析-透析間の体重増加抑制のため飲水制限を行い，透析中グリセオール投与で眼圧上昇が緩和され，透析終了3時間後には眼圧が正常化した。その後再度の眼圧上昇があり，線維柱帯切開術と周辺虹彩切除を施行したが，再び眼圧上昇したため線維柱帯切除術を施行したところ，最終的に眼圧が安定した。

結論：房水流出障害をもつ透析患者では，透析時の眼圧上昇に注意を要する。透析時の眼圧上昇では血漿浸透圧の低下を抑制することが効果的であるが，観血的治療を要する場合がある。

Abstract　Purpose：To report bilateral increase in intraocular pressure（IOP）during hemodialysis in a case with pseudophakia.

Case：A 50-year-old male had received cataract surgery in both eyes. He had only one functional kidney and started receiving hemodialysis since the age of 34 years. IOP elevation started to occur after hemodialysis. He had been treated with topical medication. He was referred to us one year before.

Findings and Clinical Course：IOP was 14 mmHg right and 24 mmHg left. Intraocular lens was adherent to the iris in the left eye. Both eyes showed wide chamber angle with increased pigmentation. No glaucomatous lesion was present in the optic nerve in either eye. After first session of hemodialysis, IOP rose to 24 mmHg right and 40 mmHg left. He was treated by reduced intake of water during intervals of hemodialysis. Glycerol intake was also useful during hemodialysis. After repeated episodes of IOP elevation during hemodialysis, the left eye received trabeculotomy, iridectomy and trabeculectomy with success.

Conclusion：IOP elevation during hemodialysis was controlled by control of plasma osmotic pressure in one eye and glaucoma surgery in the other.