網膜有髄神経線維が消失したシンナー中毒視神経症

Myelinated retinal nerve fibers disappeared in toxic optic neuropathy due to glue sniffing

　シンナー中毒による視神経症に，網膜有髄神経線維の消失が認められた1例を報告した．この観察から，本中毒視神経症で二次的に「脱髄」が起こることが確認され，本態は軸索流障害であることが推測された．

　症例　は26歳男性で，7年間のシンナー吸引歴があり，両眼の急激な視力低下のため受診した．初診時右視力は手動弁，左視力は30cm指数弁で，両眼底には乳頭周囲に網膜有髄神経線維と考えられる羽毛様白色混濁を認めた．治療により，視力・視野が著しく改善していくとともに，網膜有髄神経線維はしだいに消失し，同時に視神経乳頭は単性萎縮に至った．

　また，本症例に軽度の髄膜炎が認められたこと，ステロイド剤投与が著効したことはこれまでの報告にない点である．

A 26-year-old male, who was a habitual glue-sniffer for the past 7 years, noted sudden loss of bilateral vision after continuous sniffing for 5 days. When we saw him 5 days later, the visual acuity was hand motion right, counting fingers left. Ophthal-moscopically, we observed white, radiating, feather -like opacity along the retinal nerve fibers superior and inferior to the disc in both eyes. We assumed this opacity as myelinated retinal nerve fibers onfunduscopic and fluorescein angiographic findings.

Intensive treatment including systemic cortico-steroid resulted in dramatic improvements in visual acuity and visual field. During the course of reco-very extending over 5 months, the optic disc became atrophic with large excavation in both eyes. Concur-rently, the presumed myelinated retinal nerve fibers slowly faded out to turn into slit-like retinal nerve fiber defects.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(8) : 911-914, 1987