血液疾患における眼底所見について

Ocular fundus findings in blood diseases

　1977年1月から1989年6月までに内科及び小児科の依頼で眼科受診し，眼底検査を受けた血液疾患患者145例中58例（40％）に原疾患に起因すると思われる眼底異常を認めた。疾患により眼底像に特徴を認めた。網膜出血や綿花様白斑は殆どすべての疾患に見られた。網膜血管の蛇行は慢性白血病に多く認めた。毛細血管瘤は白血病や前白血病にのみ見られた。慢性白血病においては網膜出血を来たした症例は正常眼底の者に比較して白血球数が多い傾向を認めた（0.01＜P＜0.025）が，ヘモグロビン値，血小板数は差がなかった。骨髄腫においては網膜出血を認めた症例の尿素窒素値は正常眼底の症例に比較して高い傾向を認めた（0.005＜P＜0.01）がヘモグロビン値，血小板数，血漿蛋白は差がなかった。白血病においては網膜表層出血を伴うものは網膜深層出血主体の症例よりも白血球数（0.01＜P＜0.025）も血小板数（0.005＜P＜0.01）も少ない傾向を認めた。

We detected fundus lesions in 58 cases out of a total of 145 cases, refered to us on account of various blood diseases including leukemia, malig-nant lymphoma, myeloma, myelodysplastic syn-drome, anemia, thrombocytopenia and pure red cell aplasia during the foregoing 12-year and 6-month period. Vascular tortousity was more common in chronic leukemia than in acute leukemia or myeloma. Capillary microaneurysms were found specifically in leukemia and myelodysplastic syn-drome. In patients with chronic myeloid leukemia, leucocyte count was higher in cases with retinal hemorrhage than in those without (0.025 ＜p＜0.01). There was no correlation between retinal hemor-rhage and hemoglobin level or platelet count in chronic myeloid leukemia. In patients with myeloma, blood urea nitrogen level was higher in cases with retinal hemorrhage than in those with-out (0.001 ＜p＜0.01). There was no correlation between retinal hemorrhage and platelet count, hemoglobin level or serum protein level in myeloma. In cases with leukemia, platelet count and leucocyte count was lower in cases with super-ficial retinal homorrhage than in those with deeper one. Funduscopic examination seemed thus to be of value in the diagnosis as in predicting the hematological features in cases with leukemia or myeloma.