特発性傍乳頭脈絡膜新生血管膜にベバシズマブ硝子体注射を施行した1例

A case of peripapillary choroidal neovascular membranes treated by intravitreal bevacizumab

要約　背景：若年者での特発性傍乳頭脈絡膜新生血管膜（peripapillary choroidal neovascular membrane：PCNM）の報告は少ない。

目的：両眼に発達緑内障の既往がある成人に発症した特発性PCNMの報告。

症例：22歳の女性が1週間前からの左眼霧視で受診した。出生直後に牛眼が両眼にあり、左右眼とも各2回の線維柱帯切開術が行われている。

所見と経過：矯正視力は右1.5，左1.0で，眼圧は右12mmHg，左15mmHgであった。両眼に視神経乳頭逆位があり，左眼の乳頭に接して網膜下出血を伴う2個の網膜下黄白色病巣があった。光干渉断層計，フルオレセインとインドシアニングリーン蛍光眼底造影で，2型脈絡膜新生血管があった。明らかな原因はなく，特発性PCNMと診断した。ベバシズマブ硝子体注射を行い，5か月後に眼底所見は正常化した。

結論：若年の成人に発症した特発性PCNMに対し，ベバシズマブ硝子体注射が奏効した。

Abstract　Background: There have been few reported adult cases of idiopapthic peripapillary choroidal neovascular membrane（PCNM）in literature.

Purpose: To report idiopathic PCNM in an adult.

Case: A 22-year-old female presented with blurred vision in the left eye since one week before. She had been diagnosed with congenital glaucoma at birth and had received two sessions of trabeculotomy in either eye.

Findings and Clinical Course: Corrected visual acuity was 1.5 right and 1.0 left. Intraocular pressure was 12 mmHg right and 15 mmHg left. The left fundus showed two subretinal yellowish lesions with subretinal hemorrhage temporal to the disc. The lesions were identified as type 2 choroidal neovascularization by OCT, fluorescein and ICG angiography. As no apparent causes were detected, the lesions were diagnosed with idiopathic PCNM. Intravitreal bevacizumab was followed by normalization of fundus findings 5 months later.

Conclusion: Intravitreal bevacizumab was effective for idiopathic PCNM.