眼打撲直後に発症した急性帯状潜在性網膜外層症様の網膜障害の1例

A case of retinopathy like acute zonal occult outer retinopathy after trauma

要約　目的：急性帯状潜在性網膜外層症（AZOOR）は，眼底に明らかな異常がないにもかかわらず視力・視野障害をきたす疾患である。今回筆者らは，眼打撲直後に発症したAZOOR様の網膜障害の1例を経験したので報告する。

症例：患者は23歳，女性。もともとの矯正視力は両眼とも1.2であったが，過去に右眼打撲後の両眼の視野欠損を指摘されたことがある。水球の試合中に相手の指で右眼を打撲し，受傷直後より右眼の視力障害を自覚した。近医で精査したが，原因となりうる異常はなかった。改善がみられず，受傷後13日目に精査加療目的で昭和大学病院附属東病院眼科を紹介され受診した。

所見：矯正視力は右0.07，左1.2であった。ゴールドマン視野計（GP）で右眼視野は耳側が広範囲に欠損していた。眼底検査，光干渉断層計，蛍光眼底造影検査および頭部画像検査などで明らかな異常はなかったが，多局所網膜電図で右眼の電位は広範囲で低下していた。視機能障害を説明しうる異常所見はなく，視神経障害も否定的であったため，AZOORに類似した網脈絡膜障害と判断した。AZOORの重症例に準じ，ステロイドパルス療法を3日×2回施行した後，副腎皮質ステロイド内服を漸減した。右眼の矯正視力は徐々に改善し，最終的に1.2まで回復した。GPでの視野も6か月後には正常まで改善した。

結論：眼打撲を契機にAZOOR様の網膜障害を発症した症例を経験した。初診時の視機能障害は高度であったが，ステロイドパルス療法を選択した結果，良好な経過を得た。

Abstract　Purpose：Acute zonal occult outer retinopathy（AZOOR）is a disease that causes visual acuity and visual field disturbance despite the absence of obvious abnormalities in the fundus. In this study, we report a case of AZOOR-like retinopathy that developed immediately after eye contusion.

Case：A 23-year-old female. Her original corrected visual acuity was 1.2 in both eyes, but a visual field defect had been pointed out in the past after a bruise to the right eye. During a water polo match, her right eye was bruised by an opponent's finger, and she became aware of visual disturbance in her right eye immediately after the injury. A close examination by a local doctor revealed no abnormalities that could have caused the visual impairment. Since there was no tendency for improvement, the patient was referred to the Department of Ophthalmology, Showa University East Hospital on the 13th day after the injury for further examination and treatment.

Findings：The best corrected visual acuity（BCVA）was 0.07 in the right eye and 1.2 in the left eye, and the visual field of the right eye measured with Goldmann perimeter（GP）was extensively deficient on the temporal side. Fundus examination, optical coherence tomography, fluorescein fundus angiography, and head imaging showed no obvious abnormalities, but multifocal electroretinography showed a widespread decrease in the potential of the right eye. The patient was treated with two courses of steroid pulse therapy as in severe cases of AZOOR, followed by a gradual reduction of oral steroids. BCVA in the right eye gradually improved and finally reached 1.2. The visual field measured with GP also improved to normal after 6 months.

Conclusion：We experienced a case of AZOOR-like retinal damage caused by eye bruising. Although the visual dysfunction was severe at the time of initial examination, steroid pulse therapy was selected and the patient progressed well in the end.