色素プラークを伴う黄斑部毛細血管拡張症2型に硝子体手術が奏効した1例

Vitreous surgery was effective in a case of type 2 macular telangiectasia with pigmented plaque

要約　目的：硝子体手術が有効であった色素プラークを伴った黄斑部毛細血管拡張症2型の1症例の報告。

症例と経過：58歳，女性。右眼の視力低下を主訴に受診。初診時の最高矯正視力は左右ともに1.0で，両眼の黄斑部に黒褐色の色素沈着を認めた。OCTで，右眼は中心窩網膜の菲薄化およびellipsoid zoneの消失を認め，左眼の黄斑部には囊胞様変化を認めた。黄斑部毛細血管拡張症2型の診断で経過観察していたが，左眼黄斑部の色素沈着が徐々に拡大し，黄斑前膜様の色素プラークに進展した。初診から7年後には左眼のBCVAが0.3まで低下したため，硝子体手術を施行した。術中に色素プラークと内境界膜剝離を行い，術後も網膜内に一部色素プラークは残存しているが，術後2年半が経過しても左眼のBCVAは1.0を維持している。

結論：黄斑前膜様の色素プラークを伴った黄斑部毛細血管拡張症2型症例に硝子体手術を施行し，内境界膜ごと色素プラークを除去することで，視力が改善した。

Abstract　Purpose：To report a case of type 2 macular telangiectasia with pigmented plaque who showed improved visual acuity after vitreous surgery.

Case：A 58-year-old female presented with failing vision in the right eye as chief complaint.

Findings and Clinical Course：BCVA was 1.0 in either eye. Funduscuopy showed dark brown pigmentation in the macula in both eyes. Optical coherence tomography showed thinning of the foveal reticulum and defect of ellipsoid one in the right eye. Cystoid change was present in the left macula. The findings led to the diagnosis of type 2 macular telangiectasia. The left macular lesion with pigmentation progressed to simulate epiretinal membrane with detetioration of BCVA to 0.3 seven years later. Vitreous surgery was performed to remove the internal limiting membrane and pigmented plaque. BCVA in the left eye was maintained at 1.0 even after two and half years after surgery.

Conclusion：Visual acuity improved after vitreous surgery and removal of inner limiting membrane in an eye with type 2 macular telangiectasia with pigmented plaque simulating epiretinal membrane.