Uveal effusionと多発性後極部網膜色素上皮症

Differentiation of uveal effusion from bullous retinal detachment in two cases

　36歳男性と49歳女性の2例のuveal effusion （以下UE）を報告した．症例1は典型的な臨床症状を示したが，症例2は局所螢光漏出巣を伴い，多発性後極部網膜色素上皮症との鑑別が問題となった．UEの病態の基礎を脈絡膜循環の鬱滞と仮定すると種々の問題点が解決されるものと考えた．UEでも脈絡網膜関門の状態によって局所漏出病巣を呈する例があるが，光凝固は十分な効果を示さないものと考えた．症例2では脈絡膜剥離は認められなかったが，髄液蛋白上昇を示し，上強膜血管拡張の存在，光凝固治療の無効など，背後に脈絡膜循環障害があることが推測され，uveal effusionと診断した．

We observed two cases of uveal effusion.The first case, a 36-year-old male, presented with bilat-eral peripheral annular choroidal detachment and nonrhegmatogenous shallow retinal detachment. Fluorescein angiography showed pigment epith-elial lesions as Leopard spots in the paramacularand nasal fundus, resulting in diffuse dye leakage from the choroid in the late phase. An increase in protein content was present in the cerebrospinal fluid (59mg/dl). The choroidal and retinal deta-chments subsided spontaneously.

The second case, a 49-year-old female, presented with nonrhegmatogenous bullous detachment of the retina, shifting subretinal fluid and dilated episcleral vessels in the right eye. No choroidal detachment was observed. Fluorescein angiography showed numerous foci of dye leakage from the choroid along the upper vascular arcade. Laser photocoagulation to these foci and drainage of subretinal fluid were futile to improve the retinal detachment. An elevated protein content was seen in the cerebrospinal fluid (160mg/dl). The left eye was free of retinal detachment and showed so-called salt-and-pepper fundus.

This second case was diagnosed as a type of uveal effusion on account of the clinical features including dilated episcleral vessels, elevated protein in the CSF and failure of photocoagulation suggest-ing the venous obstruction as the basic pathogenetic process. An attempt is necessary to differentiate uveal effusion from bullous retinal detachment or multifocal posterior pigment epitheliopathy from the viewpoint of the presumed pathogenesis of uveal effusion.