片眼に網膜静脈閉塞症を合併したBehçet病の1例

A case of Behçet disease associated with unilateral branch retinal vein occlusion

要約　目的：片眼に網膜静脈分枝の閉塞があったBehçet病の症例の報告。症例：59歳男性が左眼の充血，眼痛，視力低下で受診した。左眼の視力低下は4年前にもあり，口腔アフタと下肢に結節性紅斑が頻発する既往があった。所見：矯正視力は右1.2，左0.03で，左眼は前房に炎症所見，硝子体混濁，上耳側の網膜静脈の白線化，黄斑浮腫があった。HLA-B51陽性であり，不全型Behçet病と診断した。トリアムシノロンアセトニドのテノン囊下注射を行い，前眼部の炎症と黄斑浮腫は軽減した。2か月後に左眼に硝子体出血が生じ，視力が手動弁に低下した。硝子体を切除し眼内レーザー光凝固を行った。黄斑浮腫は消失し，その4か月後に視力は0.3に改善した。結論：本症例の網膜静脈分枝の閉塞は，Behçet病による網膜静脈の血管炎による血栓形成に続発したと考えられる。初期のステロイド局所投与と硝子体出血への治療が奏効したと推定される。

Abstract.　Purpose：To report a case of Behçet disease with unilateral branch retinal vein occlusion. Case：A 59-year-old male presented with hyperemia,pain and blurring in the left eye. He had a history of oral aphtha and nodular erythema in the lower extremities. Findings：Corrected visual acuity was 1.2 right and 0.03 left. The left eye showed signs of inflammation in the anterior chamber,vitreous opacity,and macular edema. The superior temporal vein was fibrotic and was apparently occluded. HLA was positive for B51. He was diagnosed with incomplete form of Behçet disease. Intraocular inflammation and macular edema subsided after subtenon injection of triamcinolone acetonide. The left eye developed vitreous hemorrhage 2 months later and was treated by vitrectomy and laser photocoagulation. Visual acuity improved to 0.3 four months later. Conclusion：Occlusion of retinal vein may have been due to thrombosis following retinal vasculitis. Topical corticosteroid and vitrectomy may have contributed to the fair outcome.