経過観察中に退縮傾向がみられた両眼の硝子体血管系遺残の1例

A case of PFV of both eyes that regressed during follow-up

要約　目的：水晶体後面の赤色混濁を伴う両眼の硝子体血管系遺残（PFV）が経過観察中に退縮し，手術を延期した1例の報告。

症例：在胎31週2日，体重1,175gで出生した女児。出生病院でPFVを指摘され，生後2か月時に名古屋大学医学部附属病院眼科を初診。

所見：右眼は水晶体後面に広範囲の線維血管組織による赤色混濁を認め，眼底は周辺部網膜のみ透見できた。左眼は水晶体後面中央に軽度白色混濁を認めたが，眼底は透見可能であった。両眼のPFVと診断し，右眼の水晶体切除術および前部硝子体切除術を予定したが，生後3か月時に水晶体後面の混濁が白色化して減少し，眼底の視認性が著明に改善したため手術を中止した。両眼とも徐々に視力が上昇した。しかし，生後1歳をすぎた頃から視力向上が乏しくなり，生後1歳9か月時に右眼の手術を施行した。

結論：水晶体後面に高度な混濁を伴うPFVでは，形態覚遮断弱視を防ぐため早期の手術を検討する。しかし，赤色混濁の場合は出生後でも自然退縮して視認性が改善し，外科的介入を延期できる可能性があるため，適切な評価を行い，手術時期を慎重に決定する必要がある。

Abstract　Purpose：We report a case in which persistent fetal vasculature（PFV）of both eyes with posterior capsule opacification regressed during follow-up and postponed surgery.

Case：A female born at gestational age 31 weeks and 2 days with a weight of 1,175 g, was diagnosed with PFV at the birth hospital and first visited Nagoya University Hospital 2 months after birth.

Findings：The right eye showed red opacity due to a wide range of fibrous vascular tissue on the posterior of the lens, and the fundus could see only through the peripheral retina. The left eye showed white posterior capsule opacification on the center of posterior of the lens, but the fundus was transparent. We diagnosed PFV in both eyes, and lens resection and anterior vitreous resection of the right eye were scheduled. However, at 3 months of age, the opacity on the posterior of the lens became white and decreased, and the visibility of the fundus was significantly improved thus, we cancelled the operation. However, her visual acuity improved poorly after she was 1 year old, and she underwent surgery in the right eye at the age of 1 year and 9 months.

Conclusion：For PFV with hazy media, early surgery should be considered to prevent form vision deprivation amblyopia. However, opacity with hyperemia may spontaneously regress after birth and result in postponement of surgical intervention. Hense, appropriate evaluation should be performed and the timing of surgery should be carefully determined.