乳頭周囲脈絡膜分離を合併し緑内障が疑われる症例の視野障害

Visual field defect in eyes with peripapillary intrachoroidal cavitation and suspected glaucoma

要約　目的：乳頭周囲脈絡膜分離があり，緑内障が疑われる症例の視野障害の報告。対象と方法：過去5年間に緑内障が疑われ，光干渉断層計（OCT）による眼底撮影を行った792例のうち，乳頭周囲脈絡膜分離の所見がある9例13眼を対象とした。年齢は35〜66歳，平均55歳で，屈折は−10.4〜−3.6D，平均−6.6Dであり，眼軸長24.6〜27.7mm，平均26.1mmであった。乳頭周囲脈絡膜分離は4例が両眼性，5例では片眼性であった。視野はHumphreyの静的自動視野計で評価した。結果：乳頭周囲脈絡膜分離は13眼すべてで乳頭下方に局在し，これに対応する上方弓状暗点が5眼にあった。うち3眼でコーヌスと乳頭周囲脈絡膜分離の境界部で網膜神経線維層が欠損し，1眼で初診から6年後に視野障害が進行した。結論：乳頭周囲脈絡膜分離では，コーヌスとの境界部での網膜神経線維の障害が視野障害と関係し，一部の症例では視野障害が進行する可能性がある。

Abstract.　Purpose：To report the visual field defect in eyes with peripapillary intrachoroidal cavitation and suspected glaucoma. Cases and Methods：This study was made on 13 eyes of 9 cases that showed peripapillary intrachoroidal cavitation. These 13 eyes were out a larger series of 792 cases that were evaluated by optical coherence tomography（OCT）in the past 5 years. The age ranged from 35 to 66 years, average 55 years. Refraction ranged from −10.4 to −3.6 diopters, average −6.6 diopters. Axial length ranged from 24.6 mm to 27.7 mm, average 26.1 mm. Peripapillary intrachoroidal cavitation was present bilaterally in 4 cases, and unilaterally in 5 cases. Visual field was evaluated by automaterd static perimeter. Results：Peripapillary intrachoroidal cavitation was located inferior to the optic disc in all the 13 eyes. Superior arcuate scotoma corresponding to the cavitation was present in 5 eyes. In 3 out of the 5 eyes, retinal nerve fiber defects was present at the boundary of the cavitation and conus of optic disc. Visual field defect progressed in one eye during follow-up for 6 years. Conclusion：In eyes with peripapillary intrachoroidal cavitation, potentially progressive visual field defect may be located along the borderline between the cavitation and conus of the optic disc.