スペクトラルドメインOCTによりステロイド治療前後の網脈絡膜形態的変化を評価した点状脈絡膜内層症の1例

Findings by spectral domain optical coherence tomograph in a case of punctate inner choroidopathy before and after systemic corticosteroid therapy

要約　目的：スペクトラルドメイン光干渉断層計（SD-OCT）で経過を追った点状脈絡膜内層症の1症例の報告。症例：38歳女性が3週間前からの左眼変視症で受診した。近視があり，2年前に眼内レンズ挿入術を両眼に受けた。所見：矯正視力は右1.5，左0.2で，右眼には格別の異常所見はなかった。左眼後極部に境界が明瞭な小白斑が散在していた。SD-OCTで，視細胞内節エリプソイドの不明瞭化，網膜外層の反射亢進の多発，脈絡膜内層の反射亢進，脈絡膜厚の増加があった。蛍光眼底造影の所見から点状脈絡膜内層症と診断した。プレドニゾロンの経口投与を行い，2か月後に視力は0.8になり，SD-OCTでみられた網脈絡膜異常は改善した。結論：点状脈絡膜内層症の急性期には，網膜外層と脈絡膜内層に炎症性の病変があることが推定される。

Abstract.　Purpose：To report a case of punctate inner choroidopathy followed up by spectral domain optical coherence tomograph（SD-OCT）. Case：A 38-year-old female presented with metamorphopsia since 3 weeks before. She had had high myopia and received phakic intraocular lens implantation 2 years before. Findings：Corrected visual acuity was 1.5 right and 0.2 left. The right eye was free of pathological findings. The left eye showed numerous white patches with distinct margin in the central fundus. SD-OCT showed indistinct inner segment ellipsoids, multiple areas of pronounced reflex of the retinal outer layer, increased reflex of the inner choroid, and increased thickness of the choroid. Fluorescein angiography showed findings compatible with the diagnosis of punctate inner choroidopathy. Treatment with peroral prednisolone was followed by visual acuity of 0.8 two months later and by improvement in retinal and choroidal findings of SD-OCT. Conclusion：Punctate inner choroidopathy may be associated with inflammation in the outer retina and the inner choroid.