発症から1か月後に失明した網膜中心動静脈閉塞症の1例

A case of complete visual loss one month after occlusion of central retinal artery and vein

44歳女性が前日からの左眼視力低下で受診した。18歳のときから全身性エリテマトーデスがあり，プレドニゾロンを服用していた。35歳に高血圧が発症し加療中であった。矯正視力は右1.0，左光覚弁であった。左眼に乳頭浮腫と火炎状出血があり，蛍光眼底造影で網膜中心動脈には静注後10分後まで色素流入がなかった。左眼の網膜中心動静脈閉塞症と診断した。全身検査で抗リン脂質抗体症候群の状態にあった。汎網膜光凝固，ウロキナーゼ，低分子デキストラン，ワルファリンなどを投与したが，1か月後に網膜循環不全と視神経萎縮で視力が0になった。抗リン脂質抗体症候群の存在が網膜血管閉塞の背景にあったと推定した。

A 44-year-old woman presented with visual loss in her left eye since the day before. She had been treated with oral prednisolone for systemic lupus erythematosus since the age of 18. She had been diagnosed with systemic hypertension at the age of 35 years. Her corrected visual acuity was 1.0 right and light perception left. Her left eye showed optic disc edema with extensive flame-shaped hemorrhage. Fluorescein angiography showed no dye filling in central retinal artery for 10 minutes after injection. She was diagnosed with occlusion of central retinal artery and vein. Antiphospholipid syndrome was detected by laboratory studies. She received panretinal photocoagulation,systemic urokinase,low-molecular dextran and warfarin. Her vision was completely lost one month later due to retinal circulatory disturbance and optic atrophy. Presence of antiphospholipid syndrome appeared to be a major risk factor for occlusion of central retinal artery and vein.