網膜硝子体出血により牽引性網膜剝離をきたした再生不良性貧血の1例

Traction retinal detachment following vitreoretinal hemorrhage in a case of aplastic anemia

要約　目的：遷延する網膜前出血後に牽引性網膜剝離（TRD）が生じ，硝子体手術で視力が回復した再生不良性貧血の1例の報告。

症例：15歳の男性に両眼の視力低下が突発し，近医で両眼の網膜出血と網膜前出血が指摘された。強い汎血球減少があり，最重症型の再生不良性貧血と診断された。内科に入院し，眼科を紹介され受診した。

所見と経過：矯正視力は右0.7，左指数弁であった。右眼には網膜出血が多発し，黄斑部に漿液性網膜剝離（SRD）があり，左眼には後極部全体に大量の網膜前と網膜下出血があった。貧血に対する治療で，右眼の網膜出血は改善したが，左眼では硝子体混濁が遷延し，初診5か月後に再出血し，TRDが併発した。左眼に硝子体手術を行い，術中所見として血管アーケードに沿う輪状のTRDがあった。2か月後に再剝離が生じ再手術を行った。網膜は復位し，初診から20か月後の現在，右1.2，左0.2の矯正視力を維持している。

結論：本症例では，再生不良性貧血に併発した大量の網膜前出血が遷延すると，TRDが生じた。貧血に対する内科での治療と連携し，早期の硝子体手術が可能になり，視力改善が得られた。

Abstract　Purpose：To report a case of severe aplastic anemia who developed traction retinal detachment following persistent vitreoretinal hemorrhage.

Case：A 15-year-old male noted sudden visual impairment in both eyes. He was reportedly diagnosed with retinal and preretinal hemorrhage in both eyes. He was referred to us for severe aplastic anemia with pancytopenia.

Findings and Clinical Course：Corrected visual acuity was 0.7 right and counting fingers left. The right eye showed multiple retinal hemorrhage with serous retinal detachment in the macular area. The left eye showed massive preretinal and subretinal hemorrhage in the posterior fundus area. Systemic treatment for anemia was followed by improvement of hemorrhage in the right eye and by persistent vitreous opacity in the left. The left eye showed recurrence of vitreous hemorrhage followed by traction retinal detachment 5 months after his initial visit. The left eye was treated by vitreous surgery. As intraoperative finding, ring-shaped traction retinal detachment was present along the vascular arcades. Retinal detachment recurred 2 months later and was treated by vitreous surgery. The retina became reattached. Visual acuity has stabilized with 1.2 right and 0.2 left twenty months after his initial visit.

Conclusion：Traction retinal detachment developed following persistent preretinal hemorrhage as complication of aplastic anemia in the present case. Co-operation with hematologists enabled early vitreous surgery with favorable visual outcome.