妊娠中毒症を合併した妊娠・分娩の後に網膜中心静脈閉塞型乳頭血管炎をきたした1例

Postpartum optic disc vasculitis with central retinal vein occlusion in a case of toxemia of pregnancy

　26歳女性が妊娠中毒症の後，正常分娩で第1子を出産した。出産の5週間後に右眼視力が低下し，その3日後に受診した。矯正視力は右0.03，左1.5で，右眼には-3.5D，左眼には約-4.0Dの近視があった。右眼には網膜血管の強い拡張と蛇行，乳頭の発赤と腫脹，散在性の網膜出血があった。蛍光眼底造影で乳頭に過蛍光があったが，網膜血管閉塞と新生血管はなかった。視神経乳頭血管炎に併発した網膜中心静脈閉塞症と診断した。副腎皮質ステロイド薬のパルス療法，血栓溶解薬の点滴，抗凝固薬の内服を行った。発症から5週後に眼底所見は軽減し，0.8の矯正視力を得た。

A 26-year-old woman gave uneventful birth to her first baby following toxemia of pregnancy. She noticed blurring of vision in her right eye 5 weeks after birth. When seen by us 3 days later,her corrected visual acuity was 0.03 right and 1.5 left. She had myopia of-3.5 diopters in the right eye and of-4.0 diopters in the left. Her right fundus showed markedly dilated and tortuous retinal vessels,hyperemic and swollen optic disc,and sporadic hemorrhages. Fluorescein angiography showed no nonperfusion areas or neovascularization. She was diagnosed with optic disc vasculitis associated with central retinal vein occlusion. She was treated by pulsed corticosteroid,intravenous urokinase,and peroral anticoagulant. Her fundus findings showed remarkable improvement 5 weeks after onset with corrected visual acuity of 0.8.