網膜動脈分枝閉塞症により発見された左房粘液腫の1例

Branch retinal artery occlusion led to early detection of left atrial myxoma

　左眼の網膜分枝動脈閉塞症を認めた19歳の健康男子を心臓超音波検査にて左房粘液腫と診断し，左心房内腫瘍摘出術が行われた症例を報告した．この症例では起立性低血圧以外の全身所見は認められず，この起立性低血圧は腫瘍摘出手術後も続いていた．本症例の最終視力は矯正1.5と良好であった．早期診断，早期手術によってのみ完全治癒の可能な左房粘液腫の診断に，眼科医として貢献しうる最も重要なことは，網膜分枝動脈閉塞症あるいは網膜中心動脈閉塞症を若い患者の殊に左眼に見た場合には，心房粘液腫も鑑別診断の一つとして考慮し，疑わしい場合には簡便で，しかも侵襲のない心エコー検査をスクリーニング検査として行うべきであると考えた．

A 19-year-old male developed acute visual disturbance in the left eye when a playmate jumped on his shoulder. We located artery occlusions at superior nasal and inferior temporal retinal artery branches in his left eye. Three days after the inci-dent, we observed a transparent embolus, 0.4 mm in length, at the first ramification of inferior temporal branch of retinal artery.

The patient gave a history of orthostatic syncope occurring at an interval of 1 or 2 years. Except for orthostatic hypotension, he was in excellent healthcondition. There was no cardiac or vascular mur-mur, neurophysiological abnormalities, nor abnor-mal findings in CT or cerebral angiography. The blood pressure of central retinal artery showed significant fluctuations in different sessions and according to the change in posture.

We suspected systemic lesions for branch retinal artery occlusion. Echocardiogram showed typical findings of left atrial myxoma, which was subse-quently surgically treated. The final corrected visual acuity in the affected left eye was 1.5. This is the first documented case of atrial myxoma manifesting branch retinal artery occlu-sions without arterial obstructions elsewhere.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(9) : 1089-1094, 1987