ポリープ状脈絡膜血管症に対する治療により黄斑部脈絡膜陥凹が改善した1例

A case of focal choroidal excavation that improved after treatment for polypoidal choroidal vasculopathy

要約　目的：ポリープ状脈絡膜血管症（PCV）に黄斑部脈絡膜陥凹と網膜下液を合併した症例において，ベバシズマブ硝子体注入（IVB）併用光線力学療法（PDT）後に，陥凹の改善と網膜下液の吸収を認めたので報告する。症例：70歳，男性。3年前からの右眼の視力低下を訴えて来院した。所見：右眼の黄斑は暗赤色調で周囲に多発性のPCVを認め，フルオレセイン蛍光眼底撮影では黄斑部はwindow defectを呈した。光干渉断層計（OCT）にて黄斑部脈絡膜陥凹および網膜下液を認めた。IVBおよびPDT術後にポリープ状病巣の消失と網膜下液が吸収し，徐々に右眼の陥凹所見の改善と視力改善が得られた。結論：PCVを伴う黄斑部脈絡膜陥凹にはIVB併用PDTが有効であった。

Abstract.　Purpose：To report a case of focal choroidal excavation that improved after treatment for polypoidal choroidal vasculopathy. Case：A 70-year-old male presented with impaired vision in the right eye since 3 years before. Findings：Corrected visual acuity was 0.07 right and 1.0 left. The macula in the right eye appeared dark red in color and was surrounded by multiple foci of polypoidal choroidal vasculopathy. Fluorescein angiography showed window defect in the macula. Optical coherence tomograph（OCT）showed choroidal excavation and accumulation of subretinal fluid. Polypoidal choroidal vasculopathy improved with decreased subretinal fluid after intravitreal bevacizumab and photodynamic therapy. Choroidal excavation decreased 6 months later with visual acuity improving to 0.15. Conclusion：Intravitreal bevacizumab with photodynamic therapy was effective for polypoidal choroidal vasculopathy with focal choroidal excavation.