網膜中心静脈閉塞症の線溶・抗凝固療法の試み

Treatment of central retinal vein occlusion with fibrinolytico-anticoagulant preparations

　網膜中心静脈閉塞症に対して，uro-kinase 60万IUを2日間投与しwarfarinを併用した群，24万IUを4〜5日間投与（約半数例にwarfarin併用）した群で，治療効果および血液凝固・線溶能を比較検討した．

（1） urokinase 60万IU投与群，24万IU投与群ともに線溶能は亢進した．特に60万IU投与群において著明であった．

（2） urokinase単独投与では，凝固能には変化は見られなかった．warfarinのurokinase投与開始と同時併用により血液凝固能は抑制された．

（3）最良視力が得られるまでの平均期間は，uro-kinase 60万IU投与群（warfarin併用）が最も短かった．また，光凝固施行により視力の改善を得た症例が認められた．

　以上より，本症治療にurokinaseとwarfarinの併用療法および必要に応じた光凝固は有効な治療法であると考えられた．

We treated 43 eyes in 43 cases with central retinal vein occlusion by systemic administration of uro-kinase and/or warfarin. we treated 14 cases with a combined use of urokinase. 600,000 IU iv for 2 days with concomitant warfarin. 15 cases with urokinase, 240,000 IU iv for 5 days with warfarin, and 14 cases with urokinase alone.

All the cases treated with urokinase drip infusion showed remarkable increases in fibrinolytic activ-ities, particularly in the group given 600,000 IU urokinase with warfarin. Urokinae drip infusion did not influence the activity of blood coagulationfactors.

Combined use of urokinse and warfarin showed a tendency to inhibit blood coagulation. The duration between onset of therapy and attainment of best visual acuity was the shortest for the group treated with 600,000 IU urokinase com-bined with warfarin. Panretinal photocoagulation exerted a beneficial effects on visual acuity in selected cases.

The findings suggest that a combined systemic therapy with urokinse and warfarin appears to be effective in the treatment of central retinal vein occlusion. Photocoagulation is also an effective adjunct therapy in some cases.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(5) : 477-482, 1987