特異な眼底所見を呈したベーチェット病の1例

A case of Behçet's disease with uncommon fundus findings

　ベーチェット病の眼症状として，臨床的に脈絡膜炎の存在を示唆する黄斑部の著明な隆起を呈した1例を報告した．

　症例　は，41歳，ベーチェット病完全型の男性．1982年頃より眼発作を反復していたが，突然右眼の光覚を失い来院した．この時，右眼眼底には視神経乳頭上の限局した硝子体混濁，静脈の高度な拡張，蛇行，静脈に沿っての著明な滲出およびそれを縁どる形状の出血，黄斑を中心とする4-5乳頭径大の黄白色隆起を認めた．Goldmann三面鏡を用いた細隙灯顕微鏡検査により隆起は網膜色素上皮下にあり，また超音波検査で網膜面の約4mmの隆起が検出された．螢光眼底造影では螢光色素の動脈への著しい流入遅延，静脈よりの螢光色素の漏出，黄斑部の隆起に一致した脈絡膜背景螢光の増強がみられた．

　以上より本症例では高度な網膜，視神経病変のみならず，脈絡膜より網膜色素上皮下への炎症性滲出，細胞浸潤により黄斑部の隆起を生じたものと考えた．

　本症において網膜，視神経乳頭の血管を中心とする炎症性変化の報告はみられるが，高度の脈絡膜炎が臨床的にとらえられた報告はなく，貴重な症例と考えられた．

A 41-year-old male with Behçet's disease manifested a very unusual macular lesion during an acute attack. He was diagnosed as Behçet's disease 8 years before on account of aphthous stomatitis, erythema and recurrent fever. Hypopyon attacks started to recur 3 years later. He noted acute loss of vision in his right eye and sought medical advice the next day.

Opaque and elevated macula in the right fundus was the most striking funduscopic finding. It appeared yellowish-white in an area about 5 disc diameters across and protruded into the vitreous by4 mm when measured by ultrasonography. Retinal veins were dilated, with exudative or hemorrhagic patches along them. An opaque vitreous mass was located anterior to the optic disc. The anterior chamber was minimally inflamed.

The macular lesion appeared to be a massive exudative mass in the space posterior to the pig-ment epithelium when seen by slitlamp microscopy. The lesion was also characterized by early and pronounced fluorescence when seen by fluorescein angiography. These findings suggested that this very unusual macular lesion was due to acute exu-dation from the choroid.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(1) : 21-25, 1988