眼球マッサージで栓子が移動して予後良好であった網膜動脈分枝閉塞症の1例

Favorable outcome in a case of branch retinal artery occlusion following removal of embolic plaque by ocular massage

　63歳の男性に左眼視力低下が突発し，その2時問後に受診した。1年前に胸部解離性大動脈瘤の手術の既往があった。矯正視力は右1.0，左0.01で，左眼黄斑部を含む後極部に網膜混濁があり，耳上側網膜動脈に栓子があった。網膜動脈分枝閉塞症と診断し，ただちに細隙灯顕微鏡と三面鏡で眼底を観察しながら眼球マッサージを繰り返し，数分後に動脈内の栓子が末梢側に移動した。その直後に左眼視力は0.7になり，視野欠損が軽度改善した。その後栓子は消失し，視力・視野は正常化した。網膜動脈分枝閉塞症に早期の眼球マッサージが奏効した症例である。

A 63-year-old male presented with sudden visual loss in his left eye since 2 hours before. He had receivedsurgery for dissecting aneurysm of thoracic aorta one year before. His corrected visual acuity was 1.0 right and 0.01 left. Funduscopy showed retinal opacity involving the macula in the left eye. A plaque was present in the superior temporalartery. He was diagnosed with branch retinal artery occlusion. The affected eye was treated by repeated ocular massageunder direct observation of the fundus by biomicroscope and three-mirror lens. Soon thereafter, the embolic plaque movedtowards the periphery. His left visual acuity immediately improved to 0.7 followed by improved visual field defect. Theplaque disappeared a few days later associated with normalization in visual acuity and visual field. This case illustrates that ocular massage may be effective for acute retinal artery branch occlusion.