家族性滲出性網膜硝子体症での視野異常

Visual field defects in familial exudative vitreoretinopathy

　家族性滲出性網膜硝子体症60例91眼について，視野異常の形態と発生頻度，および眼底病変との関連について検討した．その結果，周辺部視野をI-4,V-4イソプターについて見ると，91眼中57眼63％は10度以上の周辺部視野異常を示していた．これらの視野変化は全て鼻側周辺部に出現し，視野狭窄または沈下として観察された．眼底病変との関連として，耳側網膜無血管野の広さおよび増殖性変化の有無による影響を3群に分類して検討した結果，無血管野の広いものでは65眼中45眼70％が10度以上の視野異常を示し，無血管野が広いもの程高度であった．この45眼中20度以上の高度な視野異常を示す29眼ではV字型変性が21眼72％に観察され，網膜無血管野とともにV字型変性が高度な視野異常の原因となっていた．増殖性の変化を持つ11眼では10眼91％に視野異常があった．このうち牽引性網膜剥離，網膜分離症が8眼80％を占めた．以上より，FEVRにおける周辺部視野異常には網膜の無血管野，V字型変性が関与しており，増殖性変化を有するものでは，眼底病変として牽引性網膜剥離，網膜分離症がその原因となっていることが判明した．

We evaluated the visual field in 91 eyes, 60 cases, with familial exudative vitreoretinopathy (FEVR). The findings were correlated against the type and severity of fundus lesions.

Visual field defects frequently involved the nasal periphery in the form of isopter contraction or depression. Contraction of V-4 and I-4 isopters by 10 degrees or more was present in 57 eyes (63%).

The series included 65 eyes with wide peripheral avascular zone. Field contraction of 10 degrees or more was present in 45 eyes (70%) in this group. Of these 45 eyes, 29 showed a marked isopter contrac-tion by 20 degrees or more. We found V-shapeddegeneration along the temporal raphe in 21 of the 29 eyes (72%).

Presence of proliferative changes in the fundus was closedly associated with visual field defects. There were 11 eyes with proliferative changes in the fundus. Visual field defects were present in 10 eyes (91%), of which 8 eyes (80%) were also affected by tractional retinal detachment or retinoschisis.

The findings indicate that visual field defects in FEVR are associated with retinal avascular zone and V-shaped degeneration. In eyes with prolifer-ative lesions, associated retinal detachment or retinoschisis may be responsible for the defective visual field.

RInsho Ganka (Jpn J Clin Ophthalmol) 42(3) : 215-221, 1988