老人性円板状黄斑変性症の早期病変—漿液性網膜剥離期の臨床的特徴

Clinical features of senile disciform macular degen-eration in the early stage

　最近5年間に，老人性円板状黄斑変性症の早期病変として，漿液性網膜剥離期の症例を77例78眼経験した。50歳以上の中高齢者の黄斑部に円板状の扁平な漿液性網膜剥離がみられた場合，常に老人性円板状黄斑変性症の早期病変を念頭におく必要がある。このような漿液性網膜剥離には色素上皮の変性萎縮，ドルーゼン，灰白色あるいは黄色の滲出斑，小出血，硬性白斑を伴っているのが特徴で，螢光眼底造影では典型的な網目状の網膜下新生血管が見られ，ときには点状の螢光漏出を示すことがあった。臨床上，中心性漿液性脈絡網膜症との鑑別が問題になる場台，新生血管を示唆するわずかの随伴症状をも見逃さないことが重要である。このような早期症例の光凝固治療成績は，80％以上に改善が得られ比較的良好であった。

We evaluated a series of 78 eyes with senile disciform macular degeneration in its early stage. All the eyes manifested serous detachment of the sensory retina in addition to neovasucular mem-brane. Remarkable subretinal fibrous proliferation was absent in the series.

As accompanying features of serous retinal detachment, we observed localized damages of retinal pigment epithelium, drusen, tiny hemor-rhages, hard lipid-like exudation, small grayish -white or yellowish exudates in the deeper retinal layers.

Fluorescein angiography showed typical lacy appearance of the choroidal neovascularizations of small sizes. Occasionally, we observed dot or small nodular hyperfluorescent areas.

Photocoagulation was performed in 68 eyes, either with red krypton laser or dye laser. Orange dye laser at 590 nm wavelength seemed to be benefi-cial.

We could confirm that the presence of serous detachment of the sensory retina in the macula in subjects over 50 years of age is highly suggestive of senile disciform macular degeneration in its early stage.