極端に網膜血管の発達が悪い未熟児網膜症の1例

A case of retinopathy of prematurity with extremely poorly developed retinal vessels

要約　目的：網膜血管の発達が極端に悪い未熟児網膜症症例の報告。症例：子宮頸部癌に対する妊孕能温存手術の後，人工授精で妊娠した母から在胎24週，出生体重588gで男子が出生した。経過：中間透光体の混濁が減少するとともに，両眼の網膜血管の先端が乳頭と黄斑の中間にあることが判明した。57～59日の間に網膜血管の怒張蛇行が急激に顕著化し，aggressive posterior retinopathy of prematurityと診断し，60日に黄斑部を含む無血管野と増殖がある有血管野に対し癒合性の配置で光凝固を両眼に行った。結果：最終的に黄斑機能は損われたが，網膜血管の怒張蛇行が軽快し，増殖所見は消失した。結論：網膜血管の発達が極端に悪い未熟児網膜症に対しては，広範囲の網膜光凝固により，網膜外への増殖が阻止できることがある。

Abstract.　Purpose：To report a case of retinopathy of prematurity with extremely poorly developed retinal vessels. Case：A male infant was born at the gestational age of 24 weeks weighing 588g. The mother had received artifificial insemination following surgery for cancer of uterine cervix. Course and Findings：After the fundus became visible,the temporal tip of retinal vessels was located between the disc and the macula in both eyes. Retinal vessels rapidly became dilated and tortuous on day 57 to 59,leading to the diagnosis of aggressive posterior retinopathy of prematurity. Photocoagulation was performed to both eyes on day 60,using confluent spots aimed at avascular area including the macula and at vascularized retina with proliferation. Results：Photocoagulation was followed by disappearance of dilatation,tortousity and proliferation of retinal vessels. Macular dysfunction became permanent. Conclusion：Extensive and dense photocoagulation may prevent progression of vascular proliferation in retinopathy of prematurity with extremely poorly developed retinal vessels.