視神経乳頭上に生じた網膜細動脈瘤の1例

Retinal arteriolar macroaneurysm on the optic disc

要約　目的：硝子体出血に対する手術で，視神経乳頭上に網膜細動脈瘤が発見された症例の報告。症例：83歳女性が6週間前からの左眼視力低下で受診した。50歳の頃から肝硬変，60歳の頃から高血圧，6週間前に食道動脈瘤破裂による吐血があった。矯正視力は右0.8，左手動弁であり，左眼には硝子体出血があった。発症から6か月後に硝子体手術を行った。術中所見として，乳頭面上に1/4乳頭径大の網膜細動脈瘤が発見された。術後視力は0.9になったが，動脈瘤は次第に大きくなり，手術19か月後に1/3乳頭径大になった。動脈瘤の器質化はなかった。結論：視神経乳頭上の網膜細動脈瘤については19例20眼の報告があるが，吸収しない硝子体出血に対して手術を要した例はない。これを発見した場合，光凝固が困難なので長期の経過観察が必要である。

Abstract.　Purpose：To report a case of macroaneurysm on the optic disc detected during vitrectomy for vitreous hemorrhage. Case：A 83-year-old female presented with blurring of vision in her left eye since 6 weeks before. She had had hepatic cirrhosis since 50 years of age, systemic hypertension since 60 years of age, and hematemesis seconary to aneurym of esophagus 6 weeks before. Her corrected visual acuity was 0.8 right and hand motion left. The left eye showed dense vitreous hemorrhage. It showed no sign of spontaneous resolution, necessitating vitrectomy 6 months after onset. A macroaneurysm was detected during surgery. It was located anterior to the optic disc and was one-fouth of optic disc in size. Visual acuity improved to 0.9. The macroaneurysm gradually enlarged to one-third of optic disc 19 months after surgery with no sign of fibrosis. Conclusion：Macroaneurysm on the optic disc has been reported in 20 eyes of 19 cases. There is no report of vitreous hemorrhage necessitating surgery. Macroaneurysm on the optic disc would require long-term observation because photocoagulation is technically impossible.