両眼脈絡膜骨腫に脈絡膜新生血管を合併した1例

A case of bilateral choroidal osteoma with choroidal neovascularization

要約　目的：ベバシズマブ硝子体注射（IVB）で加療した両眼脈絡膜骨腫例の報告。

症例および経過：39歳男性が右眼眼底出血の精査を目的として受診した。矯正視力は右1.2，左1.0であった。両眼の黄斑部に黄白色の病変が存在し，眼窩部CT検査で眼球後壁に石灰化があり，脈絡膜骨種と診断した。精査により右眼には脈絡膜新生血管（CNV）が生じていたことが判明したため，IVBを行った。右眼変視は改善したがその後，著明な漿液性網膜剝離（SRD）が生じ，IVBを2回追加したが右矯正視力は0.01まで低下した。続いて左眼に変視を自覚し，CNVを認めたため速やかにIVBを行い，初診から20か月後の現在まで矯正視力1.0を維持している。

結論：脈絡膜骨腫に伴うCNVでは，SRDが持続すると視力低下をきたすため，早期に抗VEGF薬硝子体内注射を行い，腫瘍部の活性を抑制したほうがよい。

Abstract　Purpose: To report a case of choroidal osteoma with choroidal neovascularization in both eyes.

Case: A 39-year-old man was referred to us for retinal hemorrhage in the right eye. Best corrected visual acuity（BCVA）was 1.2 in the right eye and 1.0 in the left. Both eyes showed orange-yellow lesion in the posterior fundus. Computed tomography（CT）showed dense choroidal plaque, leading to the diagnosis of choroidal osteoma in both eyes. Choroidal neovascularization was detected in the right eye by ophthalmoscopy and was treated by intravitreal bevacizumab. While metamorphopsia improved after the first session, marked serous retinal detachment was found by optical coherence tomography（OCT）. BCVA in the right eye decreased to 0.01 despite two additional sessions of intravitreal bevacizumab. A small area of choroidal neovascularization then appeared in the left eye. Prompt intraviteal bevacizumab was effective with BCVA remaining at 1.2 for one year.

Conclusion: This case illustrates that early intravitreal bevacizumab may be effective to prevent serous retinal detachment with visual loss if choroidal neovascularization is detected in an eye with choroidal osteoma.