妊娠初期に網膜動脈分枝閉塞症をきたした1例

A case of branch retinal artery occlusion during early stage of pregnancy

妊娠12週の31歳女性の右眼に網膜動脈分枝閉塞症が発症した。16か月前から黄体ホルモンと胎盤性性腺刺激ホルモンによる不妊治療を受けていた。矯正視力は右1.0，左1.2であり，右眼の網膜上半分が乳白色に混濁していた。C反応性蛋白と抗核抗体が陽性で，抗カルジオリピン抗体，プロテインC，ループス性抗凝固因子は正常範囲であった。下肢静脈エコー，心エコー検査は正常であった。黄体ホルモンのエストロゲン作用や胎盤性性腺刺激ホルモンの副作用として血栓形成と脳梗塞が挙げられている。今回の網膜動脈分枝閉塞症の発症に不妊治療薬が関与している可能性がある。

A 31-year-old female presented with branch retinal artery occlusion（BRAO）in her right eye. She was at 12 weeks of pregnancy. She had been receiving systemic progesterone and human chorionic gonadotropin for infertility since 16 months before. Her corrected visual acuity was 1.0 right and 1.2 left. BRAO involved the superior hemisphere in her right fundus. She had elevated C-reactive protein and was positive for antinuclear antibody. Anticardiolipin antibodies,protein C and lupus anticoagulant were within normal range. Venous echography of the lower limb and cardiac echography were normal. Thrombosis and cerebral infarction are known complications of systemic progesterone and chorionic gonadotropin. There is a possibility that her BRAO was causatively related with medication for infertility.