硝子体出血と乳頭周囲網膜下出血を伴った網膜動脈分枝閉塞症の1例

A case of branch retinal artery occlusion with vitreous hemorrhage and peripapillary subretinal hemorrhage

要約　目的：硝子体出血と乳頭周囲の網膜下出血を伴った網膜動脈分枝閉塞症の症例の報告。症例：78歳男性が2日前に突発した左眼下鼻側の視野欠損で受診した。左眼矯正視力は0.6で，軽度の硝子体出血と上耳側の網膜動脈の閉塞があった。乳頭は浮腫状で，その周囲に網膜前出血があった。2週後に乳頭上方に花冠状の網膜下出血が生じ，視力は0.3になった。蛍光眼底造影で上耳側動脈枝の充盈遅延と乳頭周囲毛細血管の拡張があった。4か月後に乳頭浮腫は軽快し，出血は消失し，0.9の最終視力を得た。結論：本症例での乳頭周囲の出血は，網膜中心静脈閉塞症に伴う前部虚血性視神経症による乳頭浮腫により，乳頭周囲毛細血管が破綻して生じた可能性がある。

Abstract.　Purpose：To report a case of branch retinal artery occlusion with vitreous hemorrhage and peripapillary subretinal hemorrhage. Case：A 78-year-old male presented with visual field defect in the inferior nasal sector in his left eye. The left eye showed corrected visual acuity of 0.6, vitreous hemorrhage and occlusion of superior temporal branch of retinal artery. The optic disc was edematous with peripapillary preretinal hemorrhage. Semicircular subretinal hemorrhage appeared superior to the disc with visual acuity reduced to 0.3 2 weeks later. Fluorescein angiography showed retarded dye filling in the occluded retinal artery and dilatation of peripapillary capillaries. Edema of optic disc resolved 4 months later. Peipapillary hemorrhage disappeared with visual acuity improving to 0.9. Conclusion：Peripapillary hemorrhage may have been due to rupture of peripapillary capillaries and to anterior ischemic optic neuropathy secondary to branch retinal artery occlusion.