異なる経過をたどった両眼発症網膜中心静脈閉塞症の1例

A case of bilateral central retinal vein occlusion with different clinical course in either eye

目的：両眼に発症した非虚血性網膜中心静脈閉塞症が，それぞれ異なる経過をとった症例の報告。症例：70歳女性が両眼の視力低下で受診した。矯正視力は右1.5，左眼1.0。両眼に網膜出血と黄斑浮腫があり，網膜中心静脈閉塞症と診断した。蛍光眼底造影で無灌流領域はなかった。左眼は1か月後に虚血型に移行し矯正視力0.5になった。右眼には初診の36か月後にoptociliary vein（OCV）が生じ網膜出血が減少した。左眼にはOCVの形成は一貫してなかった。結論：非虚血型の網膜中心静脈閉塞症が両眼に発症し，一眼にはOCVの形成がなく虚血型に移行し，OCVが生じた他眼は非虚血型のままであった。OCVの形成・非形成が網膜中心静脈閉塞症の経過を左右する可能性が同一症例で示された。

Purpose：To report a case of bilateral central retinal vein occlusion（CRVO）that ran a different clinical course in the right and left eye. Case：A 70-year-old woman presented with blurring in both eyes. Her corrected visual acuity was 1.5 and 1.0 left. Both eyes showed retinal hemorrhage and macular edema. The findings were compatible with nonischemic CRVO. Fluorescein angiography failed to show capillary nonperfusion. CRVO in the left eye turned into ischmic type one month later with visual acuity down to 0.5. An optociliary vein developed in the right eye 36 months after her initial visit,followed by decreased retinal hemorrhage. No optociliary vein developed in the left eye throughout. Conclusion：Initially nonischemic CRVO turned into ischemic CRVO in one eye that did not develop optociliary vein. It remained nonischemic in the fellow eye that developed optociliary vein. This bilateral case illustrates that optociliary vein may play a decisive role in the fate of CRVO.