網膜細動脈瘤21例の臨床像および視力予後

Clinical features and visual prognosis in 21 eyes with retinal arteriolar macroaneurysm

　片眼に単発した孤立性網膜細動脈瘤21症例を観察し，視力予後を検討した．症例は男性7例，女性14例で，年齢は52歳から81歳まで，平均観察期間は14ヵ月である。17例は光凝固することなく保存的に経過観察し，うち13例では視力予後が良好であった。光凝固は4例のみに施行されている。視力予後良好例は，初診時から視力低下をきたさなかったか，初診時から3ヵ月以内に視力改善傾向を示した。視力予後不良例を予測するうえで役立つ要因は，網膜細動脈瘤自体の形態学的性状や螢光眼底所見ではなく，初診時の視力と初診時の検眼鏡的所見であり，このようにして視力予後不良が予測される症例には，早期に光凝固等の治療が必要であると考えた。

We evaluated 21 eyes with unilateral solitary retinal arteriolar macroaneurysm. The series in-cluded 7 males and 14 females. The ages ranged from 52 to 81 years. The follow-up period averaged 14 months.

The natural course of the disease was followed up in 17 eyes without photocoagulation, but 4 eyes were treated with photocoagulation. Significant improvement in visual acuity resulted in the non-photocoagulated 13 eyes.

Good visual acuity at the first visit or tendency of visual improvement during initial 3 months was positively correlated with favorable visual progno-sis. Ophthalmoscopic and fluorescein angiographic appearance of macroaneurysm was irrelevant in predicting the visual prognosis, but the visual acu-ity and the general fundus finding at the first visit served as better parameters.

Photocoagulation seems to be indicated at an early stage for cases with findings suggestive of poor visual prognosis.