乳癌の脈絡膜転移による網膜全剝離1症例に対する硝子体手術の術後経過

Outcome of vitreous surgery in a case of total detachment due to choroidal metastasis from breast carcinoma

要約　目的：乳癌の脈絡膜転移による網膜全剝離に対する硝子体手術の経過の報告。

症例：63歳女性が左眼の視力低下で紹介受診した。1年前から右乳房に腫瘤があり，皮膚が潰瘍化した。2か月前から左乳房に硬結が生じた。1か月前に乳腺外科を受診し，両側の進行性乳癌と診断され，全身転移を伴っていた。

所見と経過：矯正視力は右1.0，左0.07で，左眼に裂孔不明の胞状の網膜剝離があった。硝子体手術を行い，術中に脈絡膜腫瘍のあることが判明したので，シリコーンオイルタンポナーデを行い，術後にホルモン療法を実施した。4か月後に腫瘍性隆起は消失し，0.6の視力を得た。2年後の現在まで再発はない。

結論：転移性脈絡膜腫瘍に続発した網膜全剝離に対し硝子体手術を行い，良好な結果を得た。術前診断では，画像を含め慎重な検討が必要であった。

Abstract　Purpose: To report the outcome of vitreous surgery for total retinal detachment secondary to breast carcinoma metastatic to the choroid.

Case: A 63-year-old woman was referred to us for impaired vision in the left eye. She had noticed a tumor in her right breast since one year before. A tumor appeared in her left breast 2 months before. She had been diagnosed with bilateral breast carcinoma with multiple metastatic tumors.

Findings and Clinical Course: Corrected visual acuity was 1.0 in the right eye and 0.07 in the left. The left eye showed bullous retinal detachment that appeared to be rhegmatogenous. A choroidal tumor was detected during vitreous surgery. Surgery was modified to silicone oil tamponade followed by systemic hormonal therapy. The choroidal tumor flattened 4 months later with visual acuity improving to 0.6. There has been no recurrence for 2 years until present.

Conclusion: The present case resulted in fair outcome after surgery. In retrospect, more detailed procedure was necessary including diagnostic imaging.