インフルエンザワクチン接種後に片眼性視神経乳頭炎と毛様網膜動脈閉塞症が発症した小児の1例

Unilateral optic papillitis and cilioretinal artery occlusion in a child following influenza vaccination

要約　目的：インフルエンザワクチン接種を契機として視神経乳頭炎と毛様網膜動脈閉塞を発症した小児例の報告。症例：生来健康の9歳女児。右眼の急激な視力低下を主訴に来院。右眼視力は（0.1），視神経乳頭浮腫と網膜浮腫を認め，蛍光眼底造影で毛様網膜動脈の造影遅延，光干渉断層計で網膜内層浮腫，Goldmann視野検査でMariotte盲点の拡大と鼻側の傍中心暗点を認めた。患者は発症4日前にインフルエンザ予防接種を受けていた。ステロイドセミパルス療法を行い，視力は（1.2）まで改善したが，網膜内層の菲薄化とMariotte盲点の拡大は残存した。結論：小児のワクチン接種後の視力低下では視神経炎と網膜動脈閉塞症の可能性を考える必要がある。

Abstract.　Purpose：To report a child with unilateral optic papillitis and cilioretinal artery occlusion following influenza vaccination. Case：A 9-year-old girl presented with acutely impaired vision in the right eye. She had reportedly been healthy. She had received two sessions of influenza vaccination one month and 4 days before.Findings：Corrected visual acuity was 0.1 right and 1.2 left. Myopia of about 4 diopters was present in either eye. The right eye showed retinal edema and swelling of optic disc. Fluorescein angiography showed retarded dye inflow in the cilioretinal artery. Optical coherence tomography showed edema in the inner retinal layers. Perimetry showed enlarged blind spot with paracentral scotoma. Visual acuity improved to 1.2 after systemic treatment with hydrocortisone at the daily dosis of 500 mg for 3 days followed by peroral prednisolone. Conclusion：This case illustrates that optic disc swelling or occlusion of cilioretinal artery may develop after influenza vaccination in a child.