朝顔症候群の網膜剥離

Retinal detachment in morning glory syndrome

　網膜剥離をきたした朝顔症候群の2症例を報告した。症例1の32歳男性は，下方約2象限におよぶ浅い網膜剥離を認めた。硝子体切除，眼内液空気置換術，術後光凝固の追加等で治療を試みたが復位せず，最終的にシリコンオイル注入術，眼内光凝固術を行い，網膜の完全復位を得ることができた。症例2の13歳の男子は鼻側乳頭漏斗状陥凹部のすぐ内側に非常に小さな裂孔を認め，乳頭の耳側に固定皺襞を伴った網膜剥離を認めた。硝子体切除術，眼内液空気置換術を行い，術後光凝固術を施行したが，復位が得られず，空気灌流下硝子体手術を行い，裂孔部を生体接着剤（ブチルシアノアクリレート）により閉鎖することにより，網膜の完全復位を得ることができた。2症例の経過により，朝顔症候群の網膜剥離における網膜下液の由来は，裂孔を介して網膜下腔に進入した液化硝子体であると考えた。治療は硝子体手術の応用による裂孔閉鎖が有用であると考えられる。

We treated 2 cases of retinal detachment as-sociated with morning glory syndrome. Both were males and were aged 32 and 13 years respectively. In the first case, a shallow retinal detachment extended from the excavated peripapillary area to inferior hemisphere of the right fundus. Initial attempts were futile with vitrectomy, fluid-gas exchange and postoperative laser photocoagulation around the disc area. Retinal reattachment was attained later by intravitreal silicone and endo-photocoagulation of the retina. The second case presented with total retinal detachment in the left eye. Fixed fold had formed temporal to the disc. A small retinal hole was located along the nasal margin of the anomalous disc. Retinal detachment persisted after vitrectomy, membrane peeling, fluid -gas exchange and postoperative laser photocoagulation. Retinal reattachment was finally attained by drainage of subretinal fluid, intravitreal gas and application of cyanoacrylate to the retinal break.

The findings suggest that retinal detachment in morning glory syndrome may be rhegmatogenous in nature. The retinal detachment will have to be treated, depending upon the situation, by combined use of vitrectomy, intravitreal injection of gas or silicone, postoperative photocoagulation, and retinopexy by cyanoacrylate.