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要約 目的:血管れん縮視神経網膜症の症例の報告。症例:53歳男性が呼吸困難の悪化でうっ血性心不全と診断され,緊急入院した。血圧は257/158mmHgであった。治療により血圧は正常化し,心不全と呼吸困難は改善した。入院から8日後に一過性の両眼視力障害があり,その3日後に眼科を受診した。矯正視力は右0.8,左1.2で,両眼とも乳頭が境界不鮮明で発赤・腫脹し,その周囲に軟性白斑と出血斑があった。黄斑部にかけて浮腫と星状斑があり,網膜動脈が狭細化していた。視野では両眼のMariotte盲点が拡大し,左眼の下鼻側に欠損があった。加療により全身状態が改善し,7週間後に退院した。網膜出血,白斑,乳頭から黄斑部にかけての浮腫は消退した。入院から7か月後の時点で,視力は左右とも1.2であり,Mariotte盲点の拡大はなくなったが左眼下鼻側の視野欠損は残った。結論:本症例は血管れん縮網膜症の重症型である血管れん縮視神経網膜症と診断される。これに対し,降圧治療は奏効したが,視野欠損は残存した。
Abstract. Purpose:To report a case of angiospastic neuroretinopathy. Case:A 53-year-old male was hospitalized due to difficulty in breathing and congestive heart failure. He had blood pressure of 257/158mmHg. His blood pressure was controlled by treatment with improvement in heart failure and difficulty in breathing. He developed temporary impaired visual acuity in both eyes 8 days after admission. When seen 3 days later, he had corrected visual acuity of 0.8 right and 1.2 left. Both eyes showed swollen and hyperemic optic disc surrounded by soft exudates and hemorrhagic patches. Papillomacular area showed edema and stellate patches. The retinal arteries were attenuated. Perimetry showed enlarged blind spot of Mariotte in both eyes and inferonasal defect in the left eye. He was discharged from hospital after improvement 7 weeks later. His fundus findings showed improvements in hemorrhage, exudates, and disc edema. The visual acuity improved to 1.2 in either eye. The visual field defect in the left eye persisted. Conclusion:This case was diagnosed with angiospastic neuroretinopathy secondary to systemic hypertension. The fundus lesions responded well to controlled blood pressure excepting constriction of visual field.
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