クロルプロマジン網膜症が疑われた1例

A case suspected of chlorpromazine retinopathy

要約　目的：クロルプロマジンの副作用として網膜機能障害が疑われた症例の報告。症例：50歳女性が両眼の霧視で受診した。21年前から重篤なうつ病に対し，1日量50mgのクロルプロマジンを含む10種類の薬を内服している。2年前に両眼に白内障と黄斑浮腫に対する硝子体同時手術を受けた。所見：矯正視力は右0.07，左0.6で，両眼に傍中心暗点と中心感度の低下があった。蛍光眼底造影で広範な網膜色素上皮の萎縮があり，光干渉断層計で網膜外層の菲薄化と視細胞の内節外節境界の欠損が右眼に，黄斑浮腫が左眼にあった。右眼の網膜電図はほぼ消失し，左眼の振幅が著しく低下していた。結論：この症例の汎網膜機能障害は，クロルプロマジンの長期服薬によって生じた可能性がある。

Abstract.　Purpose：To report a case with severe retinal dysfunction suspected of chlorpromazine-induced retinopathy. Case：A 50-year-old female presented with blurring of vision in both eyes. She had been receiving 10 medications including chlorpromazine 50 mg daily for severe depression since 21 years before. She had received simultaneous cataract and vitreous surgery for cataract and macular edema in both eyes 2 years before. Findings：Corrected visual acuity was 0.07 right and 0.6 left. Both eyes showed paracentral scotoma and decreased sensitivity in the fovea. Fluorescein angiography showed extensive atrophy of retinal pigment epithelium. Optical coherence tomography showed thinning of retinal outer layer and absence of borderline between outer and inner segment of visual cells in the right eye and cystoid macular edema in the left. Electroretinogram was almost extinguished in the right eye and was markedly reduced in the left. Conclusion：This case illustrates that prolonged intake of chlorpromazine at a low dosis may induce severe retinal dysfunction.