糖尿病患者に生じた両眼性一過性乳頭浮腫

Transient bilateral papilledema in a diabetic patient

　糖尿病患者の両眼に一過性の視神経乳頭浮腫をみた。42歳男性が両眼の霧視を訴え，10年来の糖尿病はインスリン治療中であった。視力は両眼1.2。視野はマリオット盲点の拡大と鼻下側の周辺部狭窄をみた。眼底は乳頭は境界不鮮明で発赤腫脹し，線条出血がみられ，後極部には小出血や硬性白斑が散在していた。螢光造影では後期に色素の漏出がみられた。血糖値は216mg／dl，HbA_1c　8.1％であった。2週間後より乳頭の腫脹は消退しはじめ，1か月半後には萎縮した。脳神経学的検査にて異常はなかった。これらより糖尿病性乳頭症と診断したが，末期に視神経萎縮が高度となったので前部虚血性視神経症との関連を考察した。

A 42-year-old male presented with bilateralblurring of vision of 10 days' duration. Diabetesmellitus had been detected 10 years before. Thestate of control was generally poor.

The visual acuity was 1.2 for either eye. Per-imetry showed enlarged blind spot and peripheralcontraction of inferior nasal field in both eyes.Fundus findings were similar in both eyes. Besidessimple diabetic retinopathy, the disc was swollenand the superficial disc capillaries were dilatedwith splinter hemorrhages and cotton-wool patchesaround the disc. Fluorescein angiography showeddye leakage from dilated disc capillaries.

The disc swelling resolved spontaneously in 2 weeks. The disc became atrophic 6 weeks later.While we diagnosed the case as diabetic papil-lopathy, we could not rule out the possibility ofanterior ischemic optic neuropathy.