下肢静脈血栓症および肺血栓塞栓症に合併した網膜中心静脈閉塞症の1例

Central retinal vein occlusion in a patient with pulmonary embolism and deep vein thrombosis

　77歳女性が，3か月前からの左眼視力低下で受診した。高血圧と高脂血症が10年前からあり，2年前に両側下肢静脈血栓症に両側下肺の血栓塞栓症を続発し，抗凝固剤ワーファリンを内服していた。矯正視力は右1.0，左手動弁であり，右眼に網膜細動脈硬化，左眼に硝子体出血があった。左眼への硝子体手術中に網膜中心静脈閉塞症が発見された。全身検索で血栓形成に関係する血液学的異常はなかった。高血圧と高脂血症により粥状動脈硬化，静脈の拡張と蛇行が続発したことが網膜中心静脈閉塞症を誘発したと推測した。本症例は，下肢静脈血栓症，肺血栓塞栓症，網膜中心静脈閉塞症が併発した最初の報告例である。

A 77-year-old woman presented with decreased visual acuity in her left eye since 3 months before. She had had systemic hypertension and hyperlipidemia since 10 years before. She had been receiving peroral warfarin for bilateral pulmonary embolism secondary to deep vein thrombosis in the lower limbs since 2 years before. Her visual acuity was 1.0 right and hand motion left. Her right eye showed retinal arteriolosclerosis. Her left eye had dense vit-reous hemorrhage. Central retinal vein occlusion was detected during vitrectomy in her left eye. Thorough hematologi-cal studies failed to show abnormal findings related to thrombosis formation. It appeared that central retinal vein occlu-sion developed secondary to systemic hypertension and hyperlipidemia leading to atherosclerosis, vasodilatation and tortuosity in the retina. This is the first reported case of deep vein thrombosis, pulmonary embolism and central retinal vein occlusion.