両眼に限局する小動脈炎性の網膜動脈分枝閉塞を繰り返した1例

A bilateral case of recurrent branch retinal artery occlusion secondary to retinal arteritis without systemic involvement

　31歳男性が前日からの右眼の暗点で受診した。両眼に白濁する網膜病変があった。蛍光眼底造影で両眼に網膜小動脈からの色素漏出が多発していた。動脈炎性の網膜動脈分枝閉塞症と推定した。プレドニゾロンの内服などでいったん軽快したが，初診から10週後に左眼に再発し，さらに4週後に右眼に再発した。膠原病を疑い，血液検査，頸動脈の超音波検査などを行ったが異常は検出されなかった。本症例には，全身的な異常がない，限局性で動脈炎性の網膜動脈分枝閉塞症が両眼にある，副腎皮質ステロイド薬に良好に反応するが減量すると再燃するなどの特徴があり，新疾患である可能性がある。

　A 31-year-old male presented with scotoma in his right eye since the day before. Funduscopy showed multiple white patches in both eyes. Fluorescein angiography showed multiple sites of dye leakage from retinal arterioles in both eyes. The findings were suggestive of branch retinal artery occlusion secondary to retinal arteritis. Peroral prednisolone was followed by resolution of fluorescein leakage. The lesions recurred in the left fundus 10 weeks after his initial visit. Another 4 weeks later,the right eye showed recurrence. Collagen disease or other systemic disorders were ruled out by examinations including hematology and ultrasonography of carotid artery. This case may be a new disease entity characterized by absence of systemic involvement,bilateral retinal arteritis resulting in branch retinal artery occlusion,response to systemic corticosteroid,and tendency to recurrences.