乳頭上網膜細動脈瘤破裂に伴い網膜動脈分枝閉塞症を発症した1例

A case of branch retinal artery occlusion following rupture of retinal arteriolar macroaneurysm on the optic disc

要約　目的：乳頭上網膜細動脈瘤破裂に伴い網膜動脈分枝閉塞症を発症した1例を報告する。

症例：48歳の男性が左眼飛蚊症，下半盲を自覚し受診した。

所見と経過：矯正視力は右1.5，左0.2で，左眼に視神経乳頭上の網膜細動脈瘤とその周囲の網膜下出血，網膜前出血，耳上側の網膜白濁を認めた。フルオレセイン蛍光眼底造影検査にて上耳側網膜動脈の灌流遅延を認めた。インドシアニングリーン蛍光眼底造影検査では乳頭上に蛍光貯留を認めた。漿液性網膜剝離を伴う黄斑浮腫に対し抗VEGF薬硝子体注射を2回施行し，黄斑浮腫，網膜下出血，網膜前出血は消失した。視力左（0.9）に改善し，治療後24か月で再発はない。

結論：本症例では，乳頭上網膜細動脈瘤破裂に伴い，網膜動脈分枝閉塞症および黄斑浮腫を認めた。乳頭上網膜細動脈瘤破裂に伴い発症した黄斑浮腫に抗VEGF薬は有用であった。

Abstract　Purpose：To report a case of branch retinal artery occlusion following rupture of retinal arteriolar macroaneurysm on the optic disc.

Case：A 48-year-old man presented with seeing floaters and visual field defect in the lower hemisphere.

Findings and Clinical Course：Corrected visual acuity was 1.5 right and 0.2 left. The left eye showed a retinal arterial macroaneurysm surrounded by sub- and pre-retinal hemorrhage. A white lesion was present in the superior temporal sector. Fluorescein angiography showed delayed dye inflow. ICG angiography showed dye pooling on the optic disc. The left eye received two sessions of vitreal bevacizumab injection. Visual acuity improved to 0.9 six months later. There has been no recurrence for 2 years until present.

Conclusion：The present case illustrates that branch retinal artery occlusion may develop after rupture of retinal arteriolar macroaneurysm. Vitreal injection of bevacizumab was apparently effective to relieve macular edema secondary to rupture of retinal arteriolar macroaneurysm.