悪性腫瘍随伴網膜症と診断された網脈絡膜病変の1例

Atypical fundus findings in a case of cancer-associated retinopathy

要約　目的：両眼のぶどう膜炎と当初診断され，最終的に悪性腫瘍随伴網膜症（cancer-associated retinopathy）と判明した症例の報告。症例：70歳女性が右眼の続発緑内障で紹介され，受診した。5年前からぶどう膜炎が両眼にあり，2年前に横行結腸癌の手術を受け，抗癌薬を内服中であった。所見：矯正視力は右0.1，左0.15で，眼圧は左右とも10mmHgであった。両眼には周辺前癒着（PAS）が隅角にあり，眼底の色素が粗で黄白色斑が散在し，動脈が狭窄していた。網膜電図は減弱し，視野狭窄があった。血清の抗リカバリン抗体が陽性であり，悪性腫瘍随伴網膜症と診断した。白内障手術を行い，右0.07，左1.0の視力を得た。初診から16か月後の現在まで，経過は良好である。結論：本症例では，結腸癌が悪性腫瘍随伴網膜症の原因であったこと，結腸癌よりも先に網膜症が発症したこと，眼病変が非特異的であったことが注目される。

Abstract.　Purpose：To report a case of cancer-associated retinopathy（CAR）with bilateral uveitis as the initial manifestation. Case：A 70-year-old woman was referred to us for secondary glaucoma in her right eye. She had been diagnosed with bilateral uveitis 5 years before. Transverse colon cancer had been detected 2 years before followed by surgery and medication with anti-cancer agent. Findings：Her corrected visual acuity was 0.1 right and 0.15 left. Intraocular pressure was 10 mmHg in either eye. Both eyes showed peripheral anterior synechia, coarse fundus pigmentation with yellow spots, and attenuated retinal arteries. Electroretinogram showed extinguished pattern. Both eyes showed constricted visual field. Serum antirecoverin antibody was positive, leading to the diagnosis of CAR. Cataract surgery was followed by visual acuity of 0.07 right and 1.0 left. She has been doing well during 16 months until present. Conclusion：The present case is unusual because colon cancer has not been known to induce CAR, ocular manifestations preceded detection of malignancy, and ocular lesions were atypical.