黄斑血腫から硝子体出血，網膜剝離をきたした網膜海綿状血管腫の1例

Macular hematoma, vitreous hemorrhage and hemorrhagic retinal detachment in a case of cavernous hemangioma

要約　目的：網膜海綿状血管腫は比較的稀な疾患で，無症状に経過することが多い。今回筆者らは，硝子体出血により急激な視力低下を認め，硝子体手術を行ったところ，出血性網膜剝離がみられた網膜海綿状血管腫の症例を経験したので報告する。

症例：53歳，女性。左眼の視力低下を主訴に前医を受診し，加齢黄斑変性による黄斑血腫が疑われ当院を紹介された。初診時矯正視力は右（1.5），左（0.1）。左眼眼底には軽度硝子体出血と黄斑部の網膜前および網膜下出血を認めた。約2か月間経過観察していたが，硝子体出血の増悪を認め，硝子体手術を施行した。眼底は鼻上側周辺部に小さな網膜裂孔を伴う網膜全剝離の状態で，網膜下に多量の出血を認めた。術後，出血吸収によって，黄斑部上方に網膜のぶどうの房状赤色腫瘤が確認され，諸検査から網膜海綿状血管腫の診断に至った。

結論：黄斑血腫，硝子体出血，出血性網膜剝離の稀な原因の1つとして，網膜海綿状血管腫がありうる。

Abstract　Purpose：To report an unusual case of cavernous hemangioma that was detected following vitrectomy for vitreous hemorrhage and hemorrhagic retinal detachment.

Case：A 53-year-old female was referred to us for sudden visual loss in the left eye since 10 days before. She was tentatively suspected of macular hematoma as complication of age-related macular degeneration.

Findings and Clinical Course：Corrected visual acuity was 1.5 right and 0.1 left. The left eye showed mild preretinal, subretinal and vitreous hemorrhage. The left eye received vitreous surgery 2 months later due to exacerbation of vitreous hemorrhage. As intraoperative finding, the retina was totally detached with a retinal break in the superior nasal periphery. Massive hemorrhage was present in the subretinal space. After removal of intravitreal silicone oil, a mass of hemangioma, simulating cluster of grapes, was found superior to the macula. This mass was diagnosed as cavernous hemangioma of the retina.

Conclusion：This case illustrates that cavernous hemangioma of the retina may manifest as macular hematoma, vitreous hemorrhage, and hemorrhagic retinal detachment.