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要約 目的:網膜色素変性による高度の視機能障害のため自覚症状がなく,見過ごされていた内頸動脈海綿静脈洞瘻の症例の報告。症例:83歳女性が右眼結膜充血で受診した。13歳のときに網膜色素変性と診断され,11年前に視覚障害者2級に認定された。1年前に両眼の白内障手術を受けた。所見:矯正視力は右0.02,左0.01であり,中心暗点があった。右眼の球結膜の拡張と蛇行,眼瞼下垂,外転障害があったが,複視の自覚はなかった。頭部の画像検査で右側の上眼静脈の拡張があり,脳血管造影で内頸動脈海綿静脈洞瘻の診断が確定した。血管塞栓術を行い,球結膜血管の拡張と蛇行ならびに外転障害は消失した。結論:網膜色素変性などで高度の視機能障害がある患者では複視を自覚しないことがあり,眼球運動の診察では注意が望まれる。
Abstract. Purpose:To report an overlooked case of carotid cavernous sinus fistula because of severely impaired visual function due to retinitis pigmentosa. Case:An 83-year-old woman presented with hyperemia in her right eye. She had been diagnosed with retinitis pigmentosa at the age of 13 years. She had received cataract surgery in both eyes one year before. Findings:Her corrected visual acuity was 0.02 right and 0.01 left. Both eyes showed central scotoma. The right eye showed dilatated and tortuous conjunctival vessels, blepharoptosis, and impaired abduction. She was unaware of diplopia. Magnetic resonance imaging showed dilatation of superior ophthalmic vein. Carotid angiography led to the diagnosis of carotid cavenous sinus fistula. Embolization of arteriovenous shunt was followed by disappearance of impaired abduction and normalization of bulbar conjunctiva. Conclusion:This case illustrates that diplopia or impaired ocular motility may be overlooked in the presence of severely impaired visual function secondary to ocular lesions including retinitis pigmentosa.
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