眼窩内病変を伴った網膜動静脈吻合の1例

A case of retinal arteriovenous communications

　10歳，女児にみられた眼窩内病変を伴うretinal arteriovenous communicationsの1例について報告した．

（1）右眼眼底には，動静脈の区別のつかない著明に拡張，蛇行した巨大な血管が視神経乳頭部から網膜全方向に拡がっているのが認められた．

（2）周辺部網膜には網膜出血，毛細血管瘤，無血管領域が認められた．

（3）患眼の視野は著明に狭窄しており，その原因は眼窩内のarteriovenousmalformationによるものと考えられた．

（4）患眼のVEPはIV, Vaがほぼ消失し，最大振幅は健眼の1／3以下であった．

（5） ERG, EOG Hght riseも健眼に比して減弱していた．

（6）本症例の視機能障害の原因は網膜異常血管による直接障害のほか，血管異常に起因する血流動態の変化による二次的な網膜および脈絡膜の障害であると推測した．また，この視機能は眼窩内異常血管の存在によりさらに強く障害されたものと考えられた．

A case of unilateral retinal arteriovenous commu-nications with orbital vascular malformation is re-ported. The patient, 10-year-old girl, was referred because of abnormal racemosous vessels around the optic disc in the right eye. Her corrected visual acuity was 0.9 in the right eye and 1.2 in the left. The visual field of the affected eye was highlyconstricted. Funduscopy revealed typical features of arteriovenous communications (group 3 of Archer) in the right eye.

Fluorescein fundus angiography revealed numero-us arteriovenous communications on and around the optic disc. The macular area was not involved. There were also microaneurysms, retinal hemorrha-ges and avascular areas in the superior temporal periphery.

EKG of the right eye was slightly attenuated. EOG L/D was 1.3 in the right eye and 2.2 in the left. Flash VEP was also attenuated. Its maximum amplitude was one third of the left eye, and IV and Va were scarcely recorded. CT scanning of the right orbit demonstrated orbital vascular malforma-tion and swelling of the optic nerve.

The changes in the visual field did not coincide with the ophthalmoscopic and fluorescein angiogra-phic findings. It is concluded that the visual field change was mainly caused by the optic nerve dama-ges induced by orbital vascular malformation.