硝子体手術を行って視神経乳頭マッサージを試みた網膜中心動脈閉塞症の1例

A case of central retinal artery occlusion treated by vitreous surgery and massage of optic nerve head

要約　目的：糖尿病網膜症による硝子体出血を伴った網膜中心動脈閉塞症に対し，硝子体手術と視神経乳頭マッサージを行った報告。症例：58歳男性に左眼の視力障害が突発し，即日受診した。2年前に糖尿病が発見され，3か月前に硝子体出血があった。所見：矯正視力は右1.5，左0.01で，左眼に桜実紅斑と硝子体出血があった。フルオレセインの静注後8分を経ても左眼網膜への流入はなかった。経過：硝子体手術を即日行い，装置の先端部で乳頭の網膜中心動脈のマッサージをした。これにより，網膜動脈内の血栓が周辺部に移動する所見が観察された。翌日の蛍光眼底造影で，腕-網膜循環時間が20秒，静脈の層流が10秒持続した。視力は6か月後に0.1に改善した。結論：高度の網膜中心動脈閉塞症では，乳頭部での網膜中心動脈のマッサージが奏効する可能性がある。

Abstract.　Purpose：To report a case of central retinal artery occlusion treated by vitreous surgery and massage of optic nerve head. Case：A 58-year-old male presented with sudden blurring in the left eye the same morning. He had been diagnosed with diabetes mellitus 2 years ago. Vitreous hemorrhage had developed 3 months before. Findings：Corrected visual acuity was 1.5 right and 0.01 left. The left eye showed cherry-red spot and vitreous hemorrhage. Fluorescein did not appear in the left fundus until 8 minutes after injection. The patient received vitreous surgery the same day. Intraoperatively,the central retinal artery was massaged at the optic nerve head by the tip of back flash needle. This manipulation was followed by downstream removal of intraarterial blood clots. Arm-to-retina circulation time improved to 20 seconds the following day with duration of laminar flow in retinal veins for 10 seconds. Visual acuity improved to 0.1 6 months later. Conclusion：This case illustrates that vitreous surgery with massage of central retinal artery at the optic nerve head may be effective for central retinal artery occlusion.