ウロキナーゼが有効であった側頭動脈炎による前部虚血性視神経症の1例

Urokinase was effective in a case of anterior ischemic optic neuropathy due to temporal arteritis

　片眼に発症後，ステロイド剤の投与中にも拘らず第2眼にも発症し，ウロキナーゼの大量投与にて軽快した，側頭動脈炎による前部虚血性視神経症の1例を報告した。

　浅側頭動脈の生検にて，リンパ球の浸潤，巨細胞の出現と，内膜及び中膜の肥厚による血管内腔の閉塞，再疎通を認め，細動脈に血栓症を引き起こし易い状態であることが推定された。このため，重篤な障害を残し易い本症の治療には，線溶療法の併用が有用であると考えた。なお，本症例では，第2眼の発症前に，すでにCT及びVEPで異常を認めており，早期診断が可能であった。

A 75-year-old male presented with anterior is-chemic optic neuropathy of recent onset in his left eye. Temporal arteritis was detected by biopsy as the underlying lesion. Systemic corticosteroid failed to induce improvement in the affected eye. A similar acute lesion developed in the right eye 10 days later. We instituted additional treatment with systemic urokinase, 120,000 units twice a day.Prompt improvement in the right eye followed the new treatment.

Biopsy of temporal artery showed occlusion of vascular lumen due to arteritis. This feature seemed to be in accord to the beneficial course of the disease after stating systemic urokinase in conjunction with systemic corticosteroid. As addi-tional findings, computed tomography (CT) and visual evoked potential (VEP) were useful in identifying the onset of lesion in the second eye, well in advance of actual visual loss.