経口避妊薬内服者に発症した半側網膜中心静脈閉塞症の1例

A case of hemicentral retinal vein occlusion following peroral contraceptive drug

要約　目的：経口避妊薬内服が発症に影響した可能性が考えられる半側網膜中心静脈閉塞症を経験したので報告する。

症例：50歳，女性。主訴は左眼視力低下。全身疾患の既往はなく経口避妊薬を内服していた。左眼底上方の半側網膜中心静脈閉塞症と囊胞様黄斑浮腫を認めた。ステロイドのテノン囊下注射および網膜無灌流領域に光凝固を施行した。出血と浮腫は徐々に軽減し，視力の改善を認めた。血液検査で，抗核抗体値，抗SS-A抗体値が軽度上昇していた。

結論：本症例は明らかな全身疾患を認めず，経口避妊薬の内服が誘因となった可能性が考えられた。女性で網膜血管閉塞性疾患を認めた場合，経口避妊薬の影響を念頭に置く必要がある。

Abstract　Purpose: To report hemicentral retinal vein occlusion in a woman who had a history of peroral contraceptive drug.

Case: A 50-year-old woman was referred to us for presumed hemicentral retinal vein occlusion. She had used ethynyl estradiol and norgestrel perorally for 3 weeks before she noticed blurring of vision.

Findings and Clinical Course: Corrected visual acuity was 1.5 right and 0.8 left. The left eye showed hemicentral retinal vein occlusion in the superior hemisphere associated with cystoid macular edema. She had no diabetes mellitus or systemic hypertension. Laboratory studies showed elevated antinuclear and anti-SS-A antibody titers. She was treated by subtenon injection of triamcinolone and by laser photocoagulation of avascular retinal area. The left fundus showed gradual resolution of cystoid macular edema and retinal hemorrhage. Visual acuity improved to 1.0 three months after start of treatment.

Conclusion: The present case illustrates that peroral contraceptive may induce vaso-occlusive retinal lesions including retinal vein occlusion.