分娩後に発症した脈絡膜循環障害によると考えられる黄斑部病変の2例

Two cases of maculopathy related to impaired choroidal circulation following childbirth

　分娩後の脈絡膜循環障害によると推定される黄斑部病変の2症例を経験した。1例は26歳で，10年前から全身性エリテマトーデス（systemic lupus erythematosus：SLE）があり，以来プレドニゾロンを服用中であった。順調な妊娠後に38週で分娩し，その直後に右眼中心暗点を自覚した。矯正視力は右0.6，左1.2であった。右眼黄斑部に2乳頭径大の隆起があったが3週後に自然寛解し，1.2の視力を得た。他の1例は31歳で，分娩後に総量7.000mlの弛緩出血で出血性ショックになり，意識が回復した2日後に左眼視力障害を自覚した。4週後に眼科を受診した。矯正視力は右1.2，左0.5であった。眼底と蛍光眼底造影所見から，中心性漿液性網脈絡膜症と診断した。分娩から8週後に自然寛解し，1.0の視力に回復した。発症機序は異なるが，両症例とも妊娠中毒症を伴わない脈絡膜循環障害による一過性の黄斑部病変であると考えた。

We observed two cases of maculopathy secondary to impaired choroidal circulation following childbirth. One was aged 26 years. She had had systemic lupus erythematosus since 10 years before and had been receiving pero-ral prednisolone. Immediately after uneventful delivery, she noticed central scoroma in her right eye. Her corrected visual acuity was 0.6 right and 1.2 left. Her right eye showed a well-defined elevation measuring 2 disc diopters in the macula. It underwent spontaneous resolution 3 weeks later with improvement of visual acuity to 1.2. The other patient was aged 31 years. Massive hemorrhage totalling 7,000 ml occurred after delivery and resulted in hemorrhagic shock. When she regained consciousness two days later, she noticed blurring of vision in her left eye. when first seen by us 4 weeks later, her visual acuity was 1.2 right and 0.5 left. Findings by ophthalmoscopy and fluorescein angiography led to the diagnosis of central serous chorioretinopathy. It spontaneous resolved 8 weeks after delivery. Both cases had no toxemia of pregnancy. The maculopathy in both cases appeared to have developed secondary to disturbed choroidal circulation.