経口避妊薬内服者と黄体ホルモン製剤内服者に発症した網膜血管閉塞疾患の2例

Two cases of retinal vascular occlusion diseases developing after peroral contraceptive or progesterone administration

要約　目的：経口避妊薬または黄体ホルモン製剤内服者に発症した網膜血管閉塞疾患の2例を経験したので報告する。

症例：症例1は37歳，女性。主訴は，突然の左上半分の視野狭窄。全身疾患の既往はなく，月経困難のため，低用量経口避妊薬を約3か月内服していた。喫煙の習慣もあった。左眼底の下耳側に網膜動脈分枝閉塞症があり，ただちに経口避妊薬を中止した。ウロキナーゼの点滴を1週間行い，その後はカリジノゲナーゼを内服した。8か月後の視力と視野狭窄は不変であった。症例2は24歳，女性。主訴は右視力低下。全身疾患の既往はなく，月経不順のため，黄体ホルモン製剤を3日間内服した。喫煙の習慣はなかった。右眼底に網膜中心静脈閉塞症があり，循環改善薬を内服した。網膜出血は徐々に消失した。

考按：2例とも，全身疾患がなく，低用量経口避妊薬または黄体ホルモン製剤を内服していた。健康な若年女性で，網膜血管閉塞疾患を生じた場合，婦人科処方薬が関与している可能性がある。

Abstract　Purpose：To report the cases of two women with retinal vascular occlusion possibly caused by intake of peroral contraceptive drug or progesterone.

Case 1：A 37-year-old woman was referred to us because of sudden loss of the visual field in her left eye. She had used drospirenone and ethynyl estradiol betadex for 3 months before she noticed the symptom. She also had a smoking habit. Her best-corrected visual acuity was 1.2 in both eyes. The left eye showed branch retinal artery occlusion in the inferior hemisphere. She had no diabetes mellitus or systemic hypertension. She was treated with urokinase injection and oral administration of kallidinogenase. The left fundus showed gradual improvement of retinal color. The visual acuity and visual field remained unchanged eight months after treatment initiation.

Case 2：A 24-year-old woman was referred to us for examination and treatment of central retinal vein occlusion. She had used dydrogesterone for 3 days before she noticed blurred vision. She did not have a smoking habit. Her best-corrected visual acuity was 1.2 in both eyes. The right eye showed central retinal vein occlusion. She had no diabetes mellitus or systemic hypertension. She was treated with oral administration of kallidinogenase. The right fundus showed gradual resolution of retinal hemorrhage. The visual acuity remained unchanged eight months after treatment initiation.

Conclusion：The present cases suggest that peroral contraceptive or progesterone administration may be associated with the onset of vascular-occlusive retinal diseases.