鼻側脈絡膜の造影遅延を認めた網膜中心動脈閉塞症と前部虚血性視神経症を合併した1例

Retarded dye inflow in the nasal choroidal hemisphere in a case of central retinal artery occlusion with anterior ischemic optic neuropathy

　68歳男性に右眼の霧視が突発し，ただちに受診した。2日前から同様の発作が頻発していた。矯正視力は右光覚弁，左1.0であった。眼底に桜実黄斑があり，網膜中心動脈閉塞症と診断した。4日後に前部虚血性視神経症の所見が生じた。蛍光眼底造影で，鼻側脈絡膜への流入遅延と視神経乳頭の過蛍光があった。磁気共鳴血管造影（magnetic resonance angiography）で，右内頸中大脳動脈系の狭窄があった。最終的に網膜の白濁は消失し，乳頭が蒼白化した。内頸動脈の狭窄部で血栓が形成され，眼内血管閉塞が生じた可能性が高い。その閉塞部が1か所であるならば，網膜中心動脈と鼻側脈絡膜を支配する短後毛様動脈が同じ部位で分岐するという血管の異型が存在する可能性がある。

　A 68-year-old man presented with sudden blurring in his right eye. He had has similar attacks since 2 days before. His corrected visual acuity was light perception right and 1.0 left. Funduscopy showed cherry-red spot,leading the diagnosis of central retinal artery occlusion. Findings of anterior ischemic optic neuropathy（AION）appeared 4 days later. Fluorescein and ICG angiography showed delayed dye inflow into the nasal choroidal hemisphere and hyperfluorescence of the optic nerve head. Magnetic resonance angiography showed constriction of right internal carotid artery. The retinal opacity ultimately disappeared with atrophic optic disc. Thrombus formation in the right internal carotid appears to have led to occlusion of central retinal artery and posterior ciliary artery irrigating the nasal choroid. There is a possibility that the branching of central retinal artery and posterior ciliary artery is located at the same site of ophthalmic artery.