網膜および網膜色素上皮過誤腫の4例

Four cases of combined hamartoma of the retina and retinal pigment epithelium

要約　目的：網膜と網膜色素上皮に生じた過誤腫4症例の報告。症例：3例は生後17か月未満の乳児，1例は42歳の女性である。主訴は乳児では斜視，成人例では視力低下で，すべて片眼性であった。所見：白色の隆起性病変が，乳児3例では黄斑部，成人例では傍乳頭部にあった。フルオレセイン蛍光造影で腫瘍内に漏出がある血管がみられ，インドシアニングリーン蛍光造影では低蛍光を示した。スペクトラルドメイン光干渉断層計で網膜内層に高反射，網膜外層に腫瘤があった。2例で網膜上膜に対し硝子体手術を行い，所見が改善した。結論：網膜と網膜色素上皮に生じた過誤腫の診断では，インドシアニングリーン蛍光造影とスペクトラルドメイン光干渉断層検査が有用であり，合併した網膜上膜には硝子体手術が有用であった。

Abstract.　Purpose：To report four cases of combined hamartoma of the retina and retinal pigment epithelium. Cases：The present series comprised 3 infants under 17 months of age and a 42-year-old female. Chief complaint was strabismus in infants and impaired visual acuity in the adult. All cases were unilaterally affected. Findings：White elevated lesion was located in the macular area in infants and near the optic disc in the adult. Fluorescein angiography showed hyperpeameable vessels within the tumor. Indocyanine green（ICG）angiography showed hypofluorescence in the tumor area. Spectral domain optical coherence tomography（SD-OCT）showed high reflex in the inner retinal layer and tumor mass in the outer layer. Vitreous surgery improved funduscopic findings in 2 eyes with epiretinal membrane. Conclusion：ICG angiography and SD-OCT were useful in the diagnosis of combined hamartoma of the retina and retinal pigment epithelium. Vitreous surgery was effective for associated epiretinal membrane.