網膜光凝固後に黄斑上膜が剥離した家族性滲出性硝子体網膜症の1例

Spontaneous separation of epiretinal membrane in a case of familial exudative vitreoretinopathy following retinal photocoagulation

要約　背景：家族性滲出性硝子体網膜症（FEVR）に対する硝子体手術では，周辺部の無血管部の硝子体の処理が一般に困難である。目的：網膜光凝固後に黄斑上膜が剥離したFEVRの症例の報告。症例：27歳男性が左眼の視力低下で受診した。矯正視力は右1.0，左0.4で，両眼に周辺部眼底の網膜血管の直線化，多分岐，広範囲の無血管野形成があり，その境界線に沿って線維血管増殖膜があった。左眼にはさらに硝子体出血と黄斑上膜があった。母親と妹に類似した眼底所見があり，FEVRと診断した。網膜の無血管野にレーザー光凝固を行い，その1か月後に左眼視力が0.7に改善し，黄斑上膜が剥離していた。結論：黄斑上膜を伴う活動性が高いFEVRでは，無血管領域を光凝固で処理する方法が治療の選択肢の1つになる。

Abstract.　Background：Vitreous surgery for familial exudative vitreoretinopathy（FEVR）may not be feasible because of difficulty in treating the vitreous facing avascular retinal area. Purpose：To report a case of FEVR who developed spontaneous separation of epiretinal membrane following laser photocoagulation. Case：A 27-year-old male presented with impaired visual acuity in the left eye. His corrected visual acuity was 1.0 right and 0.4 left. Both eyes showed linear and supernumerous retinal vessels,branchings at narrow angles,and extensive avascular zone in the peripheral retina. Fibrovascular proliferation was present along the borderline of avascular retina. The left eye showed,additionally,vitreous hemorrhage and epiretinal membrane. Similar fundus findings were present in his sister and mother,leading to the diagnosis of FEVR. Avascular area in both eyes were treated by laser photocoagulation. Left visual acuity improved to 0.7 one month later after spontaneous separation of epiretinal membrane. Conclusion：This case illustrates that photocoagulation of retinal avascular area in the periphery may be effective for active FEVR with epiretinal membrane.