網膜動脈閉塞症の予後因子の検討

Prognostic factor in retinal artery occlusion

要約　目的：過去9年間の網膜動脈閉塞症（RAO）の予後因子を検討する。対象と方法：厚生連高岡病院眼科を受診したRAOの54例54眼を対象とした。網膜中心動脈閉塞症（CRAO）27例，網膜動脈分枝閉塞症（BRAO）27例であった。平均年齢は71.1歳。年齢，性別，初診時視力，基礎疾患，発症から初診までの時間，線溶療法の有無，RAOのタイプについて，小数視力3段階以上改善または蛍光眼底造影（FA）で再疎通を改善と定義し，改善に関係する因子をロジスティック回帰分析で行った。また最終視力にかかわる因子を重回帰分析で検討した。結果：RAOの初診時視力（logMAR）0.68±0.68，最終視力0.78±1.01でCRAO，BRAO群においても有意差はなかった。基礎疾患は高血圧が最も多かった。脳梗塞を合併すると視力またはFAで改善しにくく，最終視力には初診時視力，年齢，BRAOが関係した。結論：RAOの改善（視力およびFA）には脳梗塞の既往が，最終視力には初診時視力，年齢，BRAOが関係した。

Abstract.　Purpose：To report the prognostic factors in retinal artery occlusions（RAOs）. Cases and Method：This retrospective study was made on consecutive 54 cases of retinal artery occlusion seen by us in the past 9 years. All the cases were affected unilaterally. The series comprised 27 cases each of central and branch retinal artery occlusion. The age ranged from 30 to 97 years, average 71 years. Visual acuity was evaluated as logMAR. Results：Visual acuity average 0.68±0.68 at the initial and 0.78±1.01 at the final visit. There was no difference in averaged values visual acuity between the initial and final visit in central or branch artery occlusion, or, in other words, the initial and final visual acuity was closely correlated in the 54 eyes（p＜0.0001）. Neovascular glaucoma developed in all the eyes of central retinal artery occlusion. Systemic hypertension was present in 69％ of cases, followed by cerebral infarction（48％）, heart disease（46％）and occlusion of internal cerebral artery（33％）. Presence of cerebral infarction resulted in poor visual acuity or findings by fluorescein angiography. Final visual acuity was correlated with initial visual acuity, age, and type of RAO. Conclusion：Outcome of RAO was highly correlated with findings during the initial visit.