急性単球性白血病に合併した網膜中心動脈閉塞の1例

A case of unilateral occlusion of the central retinal artery in acute monocytic leukemia

　33歳の急性単球性白血病の男子患者の再発例に合併した片眼性の網膜中心動脈閉塞症を報告した．その原因は血液粘性の増加，あるいはhyperglobulinemiaによる網膜中心動脈閉塞ではなく，視神経への白血病細胞の浸潤あるいは転移による網膜中心動脈と視神経中心動脈の機械的閉塞によるものと考えられた．しかし，罹患眼の脈絡膜循環は正常であったので，短および長後毛様体動脈には閉塞は生じていなかったと考えられた．これらの事実から，視神経への浸潤あるいは転移が考えられる白血病を代表とする全身疾患で，網膜中心動脈閉塞の発生を観察したならば，CT撮影を早急に行う必要性を痛感した．

A 33-year-old male had been suffering from acute monocytic leukemia for the past 3 years. He noted occasional blurring of vision in his right eye. Fundus-copy revealed congestion of the optic disc and dilata-tion of retinal veins. Seven days after the initial episode, acute occlusion of the central retinal artery developed in the right eye with the visual acuity reduced to light perception.

Laboratory studies failed to reveal hyperviscosity of the circulating blood nor hyperglobulinemia. The optic disc was grossly protruded. Fluorescein angiography showed absence of perfusion in the retinal vessels and the optic nerve head. Choroidal circulation appeared to be normal. The findings suggested that the occlusion of central retinal artery was caused by infiltration ormetastasis of leukemic cells in the optic nerve head while sparing the choroidal arteries. Consequent irradia-tion over the orbit with Lineac resulted in complete regression of the protrusion of the optic nerve head.

Examination with computerized tomography of the orbit is to be performed as a routine procedure in cases with retinal arterial insufficiency with systemic malig-nancies.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40 (1) : 25-29, 1986