車椅子マラソン後に発症した網膜中心動脈閉塞症の1例

A case of central retinal artery occlusion following long-distance wheelchair race

要約　目的：車椅子マラソン後に網膜中心動脈閉塞症が発症した症例の報告。症例：27歳男性が30kmの車椅子マラソン後に右眼の視力低下が生じ，その19時間後に受診した。生後6か月に脊髄損傷があり，車椅子を使っていた。所見と経過：矯正視力は右手動弁，左1.5で，右眼の相対性瞳孔求心路障害が陽性であった。右眼後極部に網膜の浮腫混濁と桜桃黄斑があった。網膜中心動脈閉塞症を疑い，眼球マッサージと前房穿刺を行った。翌日の蛍光眼底造影で眼底に循環遅延はなく再疎通していた。視力に変化はなかった。経食道心エコー検査で卵円孔開存があり，経過から奇異性塞栓症が疑われた。結論：発症機転から静脈血栓が疑われる網膜中心動脈閉塞症では，奇異性塞栓症の可能性がある。

Abstract.　Purpose：To report a case of central retinal artery occlusion（CRAO）following long-distance wheelchair race. Case：A 27-year-old male developed acute visual impairment in his right eye following 30 km race by wheelchair. He had suffered spinal injury at the age of 6 months and had been using wheelchair in his daily life. Findings：When seen 19 hours after onset,his corrected visual acuity was hand motion right and 1.5 left. The right eye was positive for relative afferent pupillary defect. The right eye showed edema and turbid retina in the posterior fundus. Cherry-red fovea was also present. He was diagnosed with CRAO and treated by ocular massage and paracentesis. Fluorescein angiography the following day showed normal perfusion. Visual acuity remained the same. Transesophageal echocardiography showed patent foramen ovale,suggesting paradoxical embolism. Conclusion：This case illustrates that CRAO may be caused by venous thrombus as manifestation of paradoxical embolism.