斑状虚血性網膜白濁を伴った乳頭血管炎4症例の臨床的特徴

Clinical characteristics in four cases of optic disc vasculitis with patchy ischemic retinal whitening

要約　目的：斑状網膜白濁を伴った乳頭血管炎4症例の臨床的特徴の報告。

症例：症例はいずれも片眼発症で，男性2例，女性2例であり，年齢は20〜41歳であった。視力はlogMARとして評価した。

所見と経過：罹患眼はすべて切迫型網膜中心静脈閉塞症の所見を呈し，斑状の網膜白濁は3眼では血管アーケードから後極側にあり，1眼では黄斑部の耳側にあった。2眼に毛様網膜動脈閉塞症の所見があり，うち1眼では網膜動脈分枝閉塞症が併発していた。相対的求心性瞳孔障害は2眼で陽性であった。中心暗点は3眼にあった。治療として前房穿刺が1例，血栓溶解療法が1例，ステロイドパルス療法が2例，抗血小板薬の内服が4例に行われた。平均視力は初診時に1.03，最終観察時に−0.01であった。

結論：若年者の乳頭血管炎は，斑状虚血性網膜白濁を伴う場合には，視力の予後が良いことを示す可能性がある。

Abstract　Purpose：To report clinical characteristics in 4 cases of optic disc vasculitis with patchy ischemic retinal whitening.

Cases：The present series comprised 2 males and 2 females. All the 4 cases were unilaterally affected. The age ranged from 20 to 41 years, average 27.5 years. Visual acuity was evaluated as logMAR.

Findings and Clinical Course：All the 4 affected eyes showed findings of impending central retinal vein occlusion. Retinal whitening was present posterior to the vascular arcade in 3 eyes and temporal to the macula in one eye. Two eyes showed cilioretinal artery occlusion. Branch retinal artery occlusion was present in one of the 2 eyes. Relative afferent pupillary defect（RAPD）was positive in 2 eyes. Central scotoma was present in 3 eyes. Paracentesis was performed in one case, thrombolytic therapy in one, and corticosteroid pulse therapy in 2 cases. All the 4 cases received thrombolytic therapy. Visual acuity averaged 1.03 initially and −0.01 at the final examination.

Conclusion：Findings in the present series seem to suggest that patchy retinal ischemic whitening in young patients of optic disc vasculitis may be signs of favorable prognosis.