裂孔併発型網膜剝離をきたしたCoats病の1例

A case of Coats disease with rhegmatogenous retinal detachment

要約　目的：裂孔併発型網膜剝離を併発し，硝子体手術を行ったCoats病症例の報告。症例：18歳男性に4年前から右眼視力低下があった。他医で治療を受け，6か月後に視力悪化で受診した。所見：矯正視力は右手動弁，左1.5で，右眼に網膜全剝離と網膜下の硬性白斑沈着があった。眼底上方に網膜円孔があり，網膜前線維増殖があった。裂孔併発型網膜剝離が併発したCoats病と診断し，硝子体手術，網膜下滲出物の除去，気体とシリコーンによる網膜伸展術を行った。術中所見として，前医による光凝固の部位に網膜前膜の牽引によると思われる網膜裂孔があった。結果は良好で，3年後の現在，0.1の右眼視力を維持している。結論：Coats病での網膜剝離は通常は滲出性であるが，光凝固による網膜前増殖膜の牽引で網膜裂孔が併発することがあり，注意が必要である。

Abstract.　Purpose：To report a case of Coats disease who received vitreous surgery for rhegmatogenous retinal detachment. Case：An 18-year-old male had noted impaired visual acuity in the right eye since 4 years before. He was referred to us for further visual impairment after treatment elsewhere for 6 months. Findings：Corrected visual acuity was hand motion right and 1.5 left. The right eye showed total retinal detachment with massive subretinal exudation and preretinal fibrous membrane. A retinal hole was present in the superior periphery. He was diagnosed with Coats disease with rhegmatogenous retinal detachment. He received vitreous surgery,removal of subretinal exudates,and retinopexy with silicone oil. A retinal tear was detected apparently due to traction of preretinal membrane during previous photocoagulation. Postoperative course was uneventful and resulted in visual acuity of 0.1 three years after surgery. Conclusion：This case illustrates that iatrogenic retinal break may be present Coats disease with exudative retinal detachment.