硝子体腔内に巨大な凝血塊が生じた真性多血症の1例

A case of polycythemia vera with massive hematoma in the vitreous

要約　目的：硝子体腔内に巨大な凝血塊が生じた真性多血症の症例の報告。症例：58歳男性が早朝からの右眼視力低下で受診した。7年前に真性多血症と診断され，加療中であった。所見：矯正視力は右0.06，左1.2で，眼圧は右66mmHg，左21mmHgであった。右眼に角膜浮腫と硝子体中の大きな凝血塊があった。末梢血液では白血球増多のみがあり，赤血球は正常範囲であった。高浸透圧薬の点滴で眼圧はさらに上昇した。ただちに水晶体乳化吸引術と硝子体切除術を行い，凝血塊と硝子体との境界が鮮明であることを確認した。複数回の硝子体手術を必要としたが，発症から1週間後に視力は1.0に回復し，眼圧も正常化した。結論：真性多血症に巨大な硝子体出血が生じる可能性がある。

Abstract.　Purpose：To report a case of polycythemia vera with massive blood clot in the vitreous. Case：A 58-year-old male presented with impaired vision in the right eye since early morning. He had been under systemic treatment for polycythemia vera since 7 years before. Findings：Corrected visual acuity was 0.06 right and 1.2 left. Intraocular pressure（IOP）was 66 mmHg right and 21 mmHg left. The right eye showed corneal edema and massive blood clot in the vitreous. The peripheral blood showed normal values for erythrocytes and increase in leukocytes. Intravenous infusion of hyperosmotic agent resulted in more elevation of IOP. Lensectomy with vitrectomy showed sharp separation between blood clot and vitreous proper. Repeated surgeries resulted in improved visual to 1.0 with normalization of IOP one week later. Conclusion：The present case illustrates that polycythemia vera may induce huge blood clot may form in the vitreous.