網膜中心静脈閉塞症に網膜動脈分枝閉塞症と硝子体出血を合併した1例

A case of central retinal vein occlusion, branch retinal artery occlusion, and vitreous hemorrhage

要約　目的：半側網膜中心静脈閉塞症に網膜動脈分枝閉塞，硝子体出血，網膜下出血を発症した1例を経験した。

症例：69歳，女性。主訴：左眼霧視，初診時視力（0.5）。耳上側網膜の白濁と乳頭周囲網膜出血および硝子体出血を認めた。

結果：ウロキナーゼ点滴後にワルファリン漸減療法を施行。硝子体出血や静脈の拡張は次第に消退し網膜下出血も減少した。7か月後，視力（1.0）に回復した。

結論：半側網膜中心静脈閉塞症に網膜動脈分枝閉塞と硝子体出血，網膜下出血がほぼ同時に合併した症例を経験した。一般に，網膜中心静脈閉塞症に網膜動脈閉塞を合併すると視力予後は不良のことが多いが，本症例は半側網膜中心静脈閉塞症のため良好であった可能性がある。

Abstract　Purpose：To report a case of central retinal vein occlusion, branch retinal artery occlusion, and vitreous hemorrhage.

Case：A 69-year-old woman was referred to us for blurring of vision in the left eye since 5 days before. She had been diagnosed with hemicentral retinal vein occlusion.

Findings and Clinical Course：Corrected visual acuity was 1.5 right and 0.5 left. The left eye showed vitreous hemorrhage, branch retinal artery occlusion in the superior temporal sector, and peripapillary retinal hemorrhage presumably due to hemicentral retinal vein occlusion in the superior hemisphere. She was treated by peroral warfarin and later by intravenous urokinase. Visual acuity improved to 1.0 following improved findings of vitreous and retinal hemorrhage, venous dilatation and tortuosity, and retinal opacity 7 months later.

Conclusion：Association of central retinal vein occlusion and branch retinal artery occlusion often results in poor visual acuity. The present case resulted in favorable visual outcome retinal veins in the superior hemisphere only were affected.