視神経浸潤を発症した急性白血病の5例

Acute leukemia invading the optic nerve in 5 cases

　視神経浸潤を来した急性白血病5例（急性骨髄性白血病3例，急性リンパ性白血病2例）の治療経過について報告した．

　いずれの症例も視神経乳頭が著しく突出し，乳頭周囲網膜が混濁していた．CTを行った3例のうち2例では，視神経が著しく腫大していた．

　3例に放射線療法を施行し，1例は眼底所見が著しく改善したが，全身状態が悪化し，死亡した．2例は視神経乳頭が萎縮したが，腫瘍の所見は消失した．全例に化学療法剤の髄液腔内注入を施行したが，大きな効果はなかった．

　白血病の視神経浸潤に対して，薬物療法は無効といわれているが，化学療法剤の効果に関して考察を行った．

　また，白血病の視神経浸潤の場合，早期に放射線療法を中心とした治療を行うことが必要であることを述べた．

Five cases with acute leukemia manifested invasionof the optic disc and optic nerve. Two cases were acute lymphoblastic leukemia and three were acute myelo-blastic leukemia. The invasion of the optic disc and nerve occurred unilaterally in 4 cases and bilaterally in one.

All the cases were treated with intrathecal meth-otrexate, arabinosyl cytosine and prednisolone. Addi-tionally, 3 cases were treated by radiation to the whole brain and the optic nerve with Linac. In general, these therapeutic modalities resulted in temporary improve-ments in ocular symptoms including disc edema, flame-shaped retinal hemorrhages and dilatation of retinal veins. Optic atrophy with markedly reduced vision was the unavoidable final result.

In all the present cases, the onset and the clinical course of optic nerve lesion was apparently independent of that of central nervous system involvement. The optic nerve lesion showed negative or poor response to intrathecally administered drugs and reacted favorably to radiation therapy. Early detection and prompt treat-ment are advocated for leukemic invasion of the optic nerve or the disc.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(8) : 891-895. 1986