輪状締結術後に一過性網膜外層斑状浮腫をきたした症例

A case of transient patchy edema in the outer retina after scleral encircling

　57歳女性が右眼網膜剝離として紹介され受診した。2か月前から右眼に飛蚊症があった。矯正視力は右眼0.1，左眼1.2であり，眼圧は右眼7mmHg，左眼12mmHgであった。右眼には上方に裂孔と限局性剝離，下方に裂孔と胞状の剝離があり黄斑に及んでいた。2日後にシリコーンスポンジで輪状締結術を行った。裂孔は冷凍凝固で処理した。経過は良好で，10日後の視力は0.2であった。手術から2か月後に網膜外層に散在性の斑状混濁が生じた。蛍光眼底造影で斑状混濁に一致して過蛍光があった。斑状混濁は緩慢に寛解し4年6か月後に消失したが，視力は0.6であった。手術の6年後に視力は1.0に回復した。手術中に一過性の高眼圧があったことが，その2か月後に網膜の斑状混濁が生じ遷延した原因である可能性がある。

　A 57-year-old female was referred to us for retinal detachment. She had been seeing flies since 2months before. Her corrected visual acuity was 0.1 right and 1.2 left. Her intraocular pressure was 7mmHg right and 12mmHg left. There were two retinal tears in the right eye. One was located at 1 o'clock surrounded by localized retinal detachment. The other was located at 6 o'clock with bullous detachment involving the macula. The affected eye was operated by scleral encircling using a silicone sponge. Retinal tears were treated by cryocoagulation. The postoperative course was uneventful. Visual acuity recovered to 0.2 10 days later. Numerous opaque patches appeared 2months later. They were located in deeper retinal layers. Fluorescein angiography showed hyperfluorescence at the sites of opaque patches. The patches subsided very gradually during the ensuing 4 years 6months. Visual acuity improved to 0.6 and later 1.0. Transient ocular hypertension during surgery may have induced this unusual fundus lesion.