両眼性視神経乳頭腫脹をきたした骨髄異形成症候群の1例

Bilateral optic disc swelling in a case of myelodysplastic syndrome

要約　目的：両眼の視神経乳頭腫脹が生じた骨髄異形成症候群の症例報告。症例：44歳男性の右眼に眼痛が生じた。3年前に汎血球減少を中軸病変とする骨髄異形成症候群と診断され，血液内科で加療中であった。矯正視力は右1.0，左1.5であり，眼圧と限界フリッカ値は正常範囲であった。右眼に視神経乳頭腫脹があり，画像診断で炎症性変化が疑われた。副腎皮質ステロイド治療で眼痛は速やかに消失したが，乳頭腫脹は完全には消退しなかった。その3か月後に右眼の乳頭腫脹が再発し，左眼にも発症した。初診から17か月の現在まで乳頭腫脹が持続しているが，眼痛はなく視力も良好である。結論：本症例の視神経乳頭腫脹は，眼窩内の炎症と異形細胞の浸潤が原因であると推定される。

Abstract.　Purpose：To report a case of myelodysplastic syndrome with bilateral swelling of optic disc. Case：A 44-year-old male prsented with pain in his right eye. He had been diagnosed with myelodysplastic syndrome with pancytopenia 3 years before. His corrected visual acuity was 1.0 right and 1.5 left. Both eyes showed normal values of intraocular pressure and critical flicker fusion frequency. His right eye showed optic disc swelling. Orbital inflammation was suspected by diagnostic imaging. Systemic corticosteroid was followed by prompt improvement of ocular pain but not of disc swelling. Three months later, disc swelling aggravated in the right eye and appeared in the left. Disc swelling is still present now 17 months after his first visit. The patient is free of ocular pain and has full visual acuity. Conclusion：There is a possibility that swelling of optic disc was caused by orbital inflammation with infiltration of inflammatory cells.