5人の脳外科医

一過性黒内障をみたら頚動脈狭窄を疑え!と教えられて頚動脈エコー、血管撮影をやっても見つけたことってありますか？　狭窄部から血栓が眼動脈へ飛んで行くというストーリーですが、実は眼動脈の血管攣縮では？という説があり、こちらの方が数としては多い印象があります。 

眼虚血症候群に対し頚動脈ステント（CAS）、頚動脈内膜剥離術（CEA）、STA-MCAバイパス術前後でcolor dopplerを使って眼循環を評価した論文があります。奈良医大脳外科の川口先生は眼循環の評価を専門にされていまして、私も学会会場でお会いしアドバイスを頂戴したことがあります。古典的ですが蛍光眼底造影で眼循環を評価したもので、残念ながらcolor dopplerではありませんでした。 

参考文献を下記に紹介します。網膜循環の評価をしてくれる眼科医が居ると楽しいのですが、私のいる地区ではまだ見つけ出していません。Color Dopplerの技術をお持ちの脳外科医、血管内治療医がいらっしゃれば是非、CAS前後で眼循環がどう変わるのか？興味があります。教えてください。 

１．Cerebrovasc Dis. 2006;22(5-6):402-8. Epub 2006 Aug 4.

Effect of carotid artery stenting on ocular circulation and chronic ocular ischemic syndrome.

Kawaguchi S, Sakaki T, et al. Department of Neurosurgery, Nara Medical University

BACKGROUND: The authors evaluated the effect of carotid artery stenting (CAS) on ocular circulation and chronic ocular ischemic syndrome. METHODS: We examined 38 patients with carotid artery stenosis (>80%) at its origin treated with CAS. Ocular circulation and symptoms were examined before, within 24 h, and 1 week, 1 month, and 3 months after CAS based on ophthalmic artery color Doppler flow imaging and ophthalmological examinations. RESULTS: Ocular circulation: Before CAS, 13 patients showed reversed ophthalmic artery flow, and 25 antegrade flow. Average peak systolic flow velocity was -0.038 m/s. Within 24 h after CAS, all patients showed antegrade ophthalmic artery flow; reversed flow before CAS was thus resolved. Average peak systolic flow velocity rose significantly to 0.36 m/s (p < 0.05). One week, 1 month and 3 months after CAS, there were no significant changes compared to the findings at 1 week after CAS. Ocular symptoms: Before CAS, 8 patients showed chronic ocular ischemic syndrome. During the follow-up period (mean: 2.8 years), the visual acuity improved in 7 cases. Average retinal artery pressure and arm-to-retina circulation time improved significantly to the normal level (p < 0.05). The other 30 patients complained of recurrent and worsened visual symptoms during the follow-up period. CONCLUSION: CAS was effective in improving ocular circulation, and also improved the chronic ocular ischemic syndrome caused by the severe carotid artery stenosis.

2. Lancet. 1999 Dec 11;354(9195):2052-3.

Effects of bypass on ocular ischaemic syndrome caused by reversed flow in the ophthalmic artery.

Kawaguchi S, Sakaki T, et al

 Superficial temporal to middle cerebral artery bypass was useful for ocular ischaemic syndrome caused by reversed flow in the ophthalmic artery as shown by ophthalmic-artery colour doppler flow imaging.

3. Cerebrovasc Dis. 2002;14(3-4):143-7.

 Hemodynamic flow patterns evaluated by transcranial color-coded duplex sonography after STA-MCA bypass for internal carotid artery occlusion.

Umemura A, Yamada K, et al

Department of Neurosurgery, Nagoya City University Medical School