光線力学的療法が奏効した限局性脈絡膜血管腫の1例

Photodynamic therapy was effective in a case of circumscribed choroidal hemangioma

要約　目的：限局性脈絡膜血管腫に対し，ベバシズマブ硝子体注射（IVB）と光線力学的療法（PDT）を施行し，良好な経過をとった1例を経験したので報告する。

症例：視力障害を呈した52歳の女性。右眼黄斑下耳側にインドシアニングリーン蛍光眼底撮影（IA）にて早期から網目状造影，後期には強い蛍光色素漏出認める約3乳頭径大の脈絡膜血管腫と黄斑に及ぶ滲出性網膜剝離を認めた。

結果：IVB併用PDTを施行し，網膜剝離とIAの漏出はやや残存。2回目PDT（単独）施行後，IAの漏出と網膜剝離ともに完全に消失した。

結論：IAでの色素漏出の消失と滲出性網膜剝離が消失したことから，本症例ではPDTによる脈絡膜血管腫の治療評価にIAが有効であった。

Abstract　Purpose：To report a case of circumscribed choroidal hemangioma treated successfully by photodynamic therapy（PDT）and intravitreal bevacizumab（IVB）.

Case and Findings：A 52-year-old-woman presented with visual impairment in her right eye, showing a choroidal hemangioma of 3 disc diameters in the temporal side of macula with exudative retinal detachment including the macula. The tumor showed net-like early hyperfluorescence and intense late hyperfluorescence by indocyanine green angiography（IA）. After the first PDT and IVB was performed, retinal detachment and hyperfluorescence by IA had remained a little. Additional single PDT was applied at the remained hyperfluorescence area by IA, retinal detachment and hyperfluorescence by IA had completely regressed.

Conclusions：It was suggested that IA may be effective for assessment of CCH treatment by PDT, because exudative retinal detachment had completely restored with the absence of subfoveal fluid when the leakage of IA had disappeard.