初回閉塞の2か月後に再発した頭痛と眼痛を伴う網膜中心動脈閉塞症の1例

Recurrence of central retinal artery occlusion with headache and eye pain two months after the initial attack

要約　目的：網膜中心動脈閉塞症が短期間で再発した1例の報告。症例：糖尿病，高血圧，動脈硬化がある64歳男性に急激な頭痛と眼痛を伴う右眼の視力低下が生じ，その40分後に受診した。毛様網膜動脈の灌流域を除く眼底に，桜実紅斑を伴うびまん性混濁があり，網膜中心動脈閉塞症と診断した。経過：前房穿刺などで所見が改善し，2週後に視力は1.0 pに回復した。抗血小板薬の内服を行っていたが，初回発作の2か月後に同様な眼痛を伴う網膜中心動脈閉塞症が再発した。治療は奏効せず，視力は10cm指数弁になった。結論：稀ではあるが，網膜中心動脈閉塞症が短期間後に再発することがある。内頸動脈狭窄，糖尿病，高血圧，動脈硬化，慢性閉塞性肺疾患などの全身病変が関与している可能性がある。

Abstract.　Purpose：To report a case of central retinal artery occlusion（CRAO）with headache and eye pain that recurred shortly after the initial attack. Case：A 64-year-old male developed blurring of vision with headache and pain in the right eye. He had a history of diabetes mellitus, systemic hypertension, and arteriosclerosis. When seen 40 minutes after the attack, the right fundus showed diffuse opacity with cherry-red fovea except the area irrigated by cilioretinal artery. He was diagnosed with CRAO. Clinical Course：Treatment by anterior chamber tapping etc was followed by recovery of visual acuity to 1.0p 2 weeks later. He was given peroral antiplatelet preparations. A similar painful attack of CRAO ccurred 2 months after the initial episode. Treatment was futile, resulting in final visual acuity of 10cm finger counting. Conclusion：Recurrence of CRAO is rare but possible. Diabetes melllitus, hypertension, carotid artery stenosis, or chronic obstructive pulmonary disorder may be involved as a contributing factor.