脳動脈瘤クリッピング手術後に網膜循環不全をきたした3例

Three cases of retinal circulatory disorder following clipping of cerebral arterial aneurysm

　くも膜下出血が，47歳男性，53歳女性，43歳男性に発症した。脳血管造影で眼動脈起始部の近くに動脈瘤が発見され，緊急クリッピング手術が行われた。全例に同側の眼瞼浮腫と患側の視力障害が術後に生じた。それぞれ術後3週，3か月，1週に眼科を受診した。患眼の矯正視力はそれぞれ指数弁，手動弁，手動弁であった。2例では乳頭が蒼白で網膜動脈が狭細化し，網脈絡膜萎縮の所見を呈した。第3例では初診時には眼底が正常であったが，2週後に同様の所見が生じ，眼球運動制限が起こった。クリッピング手術後の視力障害の原因として知られている術中の眼動脈，視神経，眼窩先端部への圧迫はなく，発症原因は特定できなかった。

Subarachnoid hemorrhage developed in three cases. The series comprised 47-year-old male, 53-year-old female and 43-year-old male. Cerebral angiography showed an aneurysm near the site of origin of ophthalmic artery in all the cases. Clipping of the aneurysm through the front-temporal approach was performed as emergency surgery. Ipsilateral visual disturbance associated with palpebral edema developed after surgery. Ophthalmological examination was performed 3 weeks, 3 months and one month respectively after surgery. The corrected visual acuity was finger counting, hand motion and hand motion roespectively. Two cases showed optic disc pallor, attenuated retinal arteries and retinochoroidal atrophy. The third case showed normal fundus initially but showed similar fundus lesions as the other two cases one week later. Restricted ocular motility also developed. The case of retinal vascular disorder could not be identified, as intraoperative compression to the ophthalmic artery, optic nerve or orbital apex were ruled out in all the cases.