硝子体手術により血流改善を認めた切迫型網膜動脈分枝閉塞症の1例

Vitreous surgery improved retinal circulation in a case of impending branch retinal artery occlusion

　63歳女性が右眼視野欠損で即日受診した。心房細動と僧帽弁狭窄症があり，15年前からワーファリンを内服中であった。白内障があり，矯正視力は右0.6，左0.8であった。右眼の上耳側動脈起始部に狭細があり，切迫型網膜動脈分枝閉塞症と診断した。ウロキナーゼ点滴を6日間実施したが，血流障害が増悪し黄斑浮腫が増加した。発症から15日後に硝子体手術を行い，意図的に硝子体剝離を作製したあと，動脈狭細部をマッサージした。その1週間後から黄斑浮腫は徐々に軽減し，血流が改善した。0.9の最終視力を得た。切迫型網膜動脈分枝閉塞症に硝子体手術が奏効したと考えられる症例である。

　A 63-year-old woman presented with visual field defect in her right eye. She had been receiving peroral warfarin for atrial fibrillation and mitral stenosis since 15 years before. When seen on the day of onset,her corrected visual acuity was 0.6 right and 0.8 left. A stenosis was present at the origin of superior temporal retinal artery in the right eye,leading to the diagnosis of impending branch retinal artery occlusion（BRAO）. Intravenous infusion of urokinase for 6 days was followed by further impairment of retinal circulation and increase of macular edema. She received vitreous surgery on day 15 of the disease. After intentional posterior vitreous detachment,massage was applied to the site of stenosis. Retinal circulation started to improve one week after surgery,resulting in the final visual acuity of 0.9. Vitreous surgery was apparently effective for impending BRAO in this particular case.