内頸動脈狭窄症に併発した網膜中心動静脈閉塞症の1例

Combined occlusion of central retinal artery and vein in a case of stenosis of internal carotid artery

　68歳男性の左眼に視力低下が突発し，その翌日に受診した。矯正視力は右1.0，左0.02であった。左眼には網膜全面に網膜出血があり，後極部網膜が白濁していた。蛍光眼底造影検査で，網膜動脈への高度の流入遅延と網膜内循環時間の遅延があった。網膜中心動静脈閉塞症と診断し，眼球マッサージ，ウロキナーゼとプロスタグランディンE₁の点滴静注，星状神経節ブロックを行った。眼底所見と網膜循環は急速に改善し，7週後に視力が0.6に回復した。治療中に行った磁気共鳴血管造影magneticresonance anglography （MRA）で，両側の内頸動脈が高度に狭窄していた。本症例の網膜中心動静脈閉塞症は，頸動脈病変からの塞栓によると推定された。

A 68-year-old man presented with sudden visual loss in his left eye since the previous day. His corrected visual acuity was 1.0 right and 0.02 left. The left eye showed extensive retinal hemorrhages and turbid posterior retina. Fluorescein angiography showed grossly delayed retinal arterial inflow and increased intraretinal circulation time. He was diagnosed with combined occlusion of central retinal artery and vein. He received ocular massage, intravenous urokinase and prostaglandin E₁, and stellate ganglion block. The affected eye showed rapid improvements in fundus finding and retinal circulation. His left visual acuity improved to 0.6 7 weeks later.Magnetic resonance angiography showed severe bilateral stenosis of internal carotid artery. It appeared that combined occlusion of central retinal artery and vein was caused by an embolus migrating from the stenosed internal carotid artery.