特発性網膜動脈分枝閉塞症の1例

A case of idiopathic branch retinal arterial occlusion

要約　目的：若年者の両眼に発症した網膜動脈分枝閉塞症の報告。症例：27歳男性が右眼の視野欠損を自覚し，同日受診した。矯正視力は右1.2，左1.5であり，右眼には上鼻側，左眼には網膜動脈分枝の閉塞と網膜の白色化があった。網膜動脈炎による網膜動脈閉塞が疑われた。血液検査，心電図，全身の磁気共鳴断層検査（MRI），脳血管造影検査では異常がなかった。ウロキナーゼの全身投与と高圧酸素療法で網膜閉塞部の再疎通は得られなかった。プレドニゾロンとアスピリンなどの内服で視野が改善し，網膜動脈閉塞部の拡大が停止した。プレドニゾロンの減量で網膜動脈閉塞と視野欠損が悪化したので，ステロイドパルス療法を行った。視野変化はほぼ停止し，18か月後の現在まで病状は安定している。結論：両眼性の網膜動脈分枝閉塞症の本症例は，原因不明であり，抗凝固薬と副腎皮質ステロイドに反応せず，ステロイドパルス療法に抵抗した。

Abstract.　Purpose：To report a juvenile case of bilateral branch retinal artery occlusion. Case：A 27-year-old male presented with acute visual field defect in the right eye since a few hours before. His corrected visual acuity was 1.2 right and 1.5 left. The right eye showed occlusion of superonasal retinal artery. A similar lesion was present in the left eye. The findings were suggestive of branch retinal artery occlusion secondary to retinal arteritis. Systemic examinations, including hematology, electrocardiogram, magnetic resonance imaging（MRI）, and cerebral angiography, showed unremarkable findings. No recanalization of retinal artery occlusion occurred after systemic urokinase and hyperbaric oxygen therapy. Peroral prednisolone and aspirin was followed by improved visual field defect and no further progression of retinal artery occlusion. Visual field defect and retinal artery occlusion exacerbated after tapering of prednisolone. Pulsed corticosteroid therapy was followed by stabilization of visual field defect for 18 months until present. Conclusion：Bilateral branch retinal artery occlusion in the present case was idiopathic, unresponsive to systemic anticoagulant or corticosteroid, and failed to improve after pulsed corticosteroid therapy.