眼トキソプラズマ症に続発した黄斑円孔の自然閉鎖例

A case of spontaneously closed macular hole secondary to ocular toxoplasmosis

要約　目的：眼トキソプラズマ症に続発した黄斑円孔が自然閉鎖した症例の報告。症例：55歳男性が3週間前からの右眼中心暗点で受診した。矯正視力は右0.2，左1.2で，両眼とも－3.5Dの近視があった。右眼の黄斑近傍に1.5乳頭径大の滲出斑があり，血清の抗トキソプラズマ値が5,120倍で，眼トキソプラズマ症と診断し，アセチルスピラマイシンを経口投与した。2週間後に黄斑円孔が生じた。視力は不変であった。3か月後に黄斑円孔は自然閉鎖し，光干渉断層計（optical coherence tomography：OCT）で観察された中心窩外層の剝離様所見はその3か月後に消失した。最終視力は0.3であった。結論：眼トキソプラズマに併発した黄斑円孔は，自然閉鎖することがある。

Abstract.　Purpose：To report a case of paramacular toxoplasmosis followed by macular hole that spontaneously closed later. Case：A 55-year-old male presented with central scotoma in the right eye since 3 weeks before. Visual acuity was 0.2 right and 1.2 left when corrected for －3.5 diopters. The right eye showed an exudative patch of 1.5 disc diameter across. Anti-toxoplasmosis titer in the serum was 5,120 fold, leading to the diagnosis of ocular toxoplasmosis. After peroral treatment with acetylspiramycin, the right eye developed macular hole 2 weeks later. The visual acuity remained unchanged. The macular hole spontaneously closed 3 months later. Optical coherence tomography（OCT）showed fluid accumulation in the outer layer of the fovea that disappeared another 3 months later with final visual acuity of 0.3. Conclusion：This case illustrates that macular hole secondary to ocular toxoplasmosis may resolve spontaneously.