不妊治療中に網膜動静脈閉塞症をきたした1例

A case of branch occlusion of retinal artery and vein during treatment for infertility

要約　目的：不妊治療中に網膜動静脈枝の閉塞が生じた症例の報告。症例：32歳女性が4か月前からの右眼視野欠損の発作で受診した。7か月前からエストロゲンとプロゲステロン内服による不妊治療を受けていた。所見：裸眼視力は左右眼とも1.5で，右眼の上耳側静脈の領域に出血と血管の白鞘化があり，それに相当する視野欠損があった。左眼には異常がなかった。蛍光眼底造影で右眼の上耳側動静脈に循環遅延があり，網膜動静脈枝の閉塞と診断した。高血圧，糖尿病，脂質異常症はなく，血液の一般検査所見は正常であった。初診の2週間後と10週間後に硝子体出血が生じ，新生血管と無灌流部に光凝固を行った。初診から11か月後の現在まで経過は良好である。結論：本症例では不妊症に対するホルモン療法が網膜動静脈枝の閉塞の原因になった可能性がある。

Abstract.　Purpose：To report a case of branch occlusion of retinal artery and vein during treatment for infertility. Case：A 32-year-old female presented with repeated attacks of visual field defect in the right eye since 4 months before. She had been receiving treatment for infertility with peroral estrogen and progesterone preparations since 7 months before. Findings：Her uncorrected visual acuity was 1.5 in either eye. The right eye showed hemorrhage and sheathing of vessels in the retinal area supplied by superior temporal vein. Visual field defect was present in the area corresponding to the fundus lesion. The left eye showed normal findings. Fluorescein angiography showed delay in perfusion through the superior temporal artery and vein,leading to the diagnosis of branch occlusion of retinal artery and vein. She was free of hypertension,diabetes mellitus,collagen disease,or hematological disorders. She developed vitreous hemorrhage 2 and 10 weeks after her initial visit. Photocoagulation was applied to neovascularization and avascular retinal area. She is doing well for 11 months until present. Conclusion：There is a possibility that hormonal treatment for infertility is causatively related with branch occlusion of retinal artery and vein in this patient.