若年の1型糖尿病患者に発症した前部虚血性視神経症の1例

Anterior ischemic optic neuropathy in a young patient of type 1 diabetes mellitus

　31歳女性が右眼霧視と視野異常で受診した。8年前に1型糖尿病と診断され，3年前から経口糖尿病薬，2年前からインスリン投与を受け，1年前に汎網膜光凝固が両眼に行われた。矯正視力は両眼とも1.0であった。右眼に顕著な乳頭浮腫と下鼻側の傍中心暗点があり，前部虚血性視神経症（AION）と診断した。発症翌日から1か月間ステロイド薬の内服を行った。視力低下はなく，視野障害も悪化しなかった。若年の1型糖尿病に併発したAIONに，巌格な血糖コントロールとステロイド薬内服が奏効することを示す症例である。

A 31-year-old female presented with blurred vision and visual field defect in her right eye of recent onset. She had been diagnosed with typel diabetes mellitus (IDDM) 8 years before. Treatment with peroral antidiabetics had started 3years before. Insulin had started 2years before. Both eyes had received panretinal photocoagulation one year before. Her corrected visual acuity was 1.0 in either eye. Her right eye showed optic disc edema and paracentral scotoma in the inferior nasal sector, leading to the diagnosis of anterior ischemic optic neuropathy (AION). She was treated with systemic corticosteroid from the next day of onset to be continued in decreasing dosis for one month. She showed no visual impairment nor further deterioration in the visual field. This case illustrates that AION in young patient of IDDMmay respond favorably to strict control of blood sugar level and systemic corticosteroid.