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要約 目的:黄斑上膜を伴う黄斑円孔に対する硝子体手術後に後天青黄色覚異常が生じた症例の報告。症例:49歳女性。3年前からの右眼変視症が悪化し,黄斑円孔が発見され,硝子体手術を受けた。インドシアニングリーン(ICG)染色による内境界膜剝離を併用した。変視症が改善し,視力は1.0と不変であったが,色覚の左右差を訴えるようになった。所見:諸検査で青黄色覚異常が証明され,これに特有な色誤認があった。色覚異常は術後1年の現在まで続いている。結論:術後の青黄色覚異常が,内境界膜剝離による機械的損傷,ICGの毒性,青錐体系の脆弱性の個体差によって起こった可能性がある。ICG併用の黄斑手術では色覚異常が惹起されうることに留意する必要がある。
Abstract. Purpose:To describe a case who developed blue-yellow color deficiency after vitreous surgery for macular hole. Case:A 49-year-old female noted progressive metamorphopsia in her right eye since 3 years before. She was diagnosed with macular hole and received vitreous surgery with peeling of epiretinal membrane. Staining with indocyanine green(ICG)was used to stain the internal limiting membrane(ILM)and ILM was removed. Metamorphopsia subsided after surgery and the visual acuity remained at 20/20. The patient started to complain disturbed color vision. Findings:Various tests showed blue-yellow color deficiency persisting during the follow-up of one year after surgery. Conclusion:There is a possibility that the blue-yellow deficiency was induced by trauma to the ILM,toxicity of ICG,or personal weakness of blue cone system. Due attention is necessary for this type of complication in vitreous surgery for macular hole with adjunctive use of ICG.
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