網膜中心静脈閉塞症に合併した網膜中心動脈閉塞症および脈絡膜循環不全の1例

Central retinal artery occlusion and disturbed choroidal circulation in a case of central retinal vein occlusion

　68歳女性が左眼の飛蚊症で受診した。動脈硬化症，糖尿病，僧帽弁と三尖弁の閉鎖不全があり，慢性腎不全に対して透析を受けていた。左眼矯正視力は0.4であった。非虚血型網膜中心静脈閉塞症と診断し，罹病期間の短縮と増悪予防のためにレーザー光凝固を行った。改善がないために，ウロキナーゼとプロスタグランディンE₁リポ化製剤の点滴と，星状神経節ブロックを行った。初診から2週間後に虚血型網膜中心静脈閉塞症に進行し，網膜中心動脈閉塞症と脈絡膜循環障害が併発した。全身疾患が増悪因子の1つであると推定した。

A 68-year-old female presented with seeing flies in her left eye. She had had arteriosclerosis, diabetes mellitus, and insufficiency of mitral and tricuspidal valves. She had been receiving hemodialysis for chronic renal insuf-ficiency. Her visual acuity was 0.4 left. We diagnosed her with nonischemic central retinal vein occlusion (CRVO). La-ser photocoagulation failed to improve the fundus findings. She was then treated with stellate ganglion block and drip infusion of urokinase and prostaglandin E₁. She developed, 2 weeks after initially seen by us, ischemic CRVO associ-ated with central retinal artery occlusion and disturbed choroidal circulation. The presence of systemic lesions ap-peared to have contributed to aggravation of CRVO in this patient.