広範囲に網膜下索状物を伴う胞状網膜剝離を認めた劇症型中心性漿液性網脈絡膜症の1例

A case of fulminant central serous chorioretinopathy with bullous retinal detachment and extensive subretinal strands

要約　目的：若年女性の片眼に発症した，広範囲にわたる網膜下索状物と胞状網膜剝離を伴う劇症型中心性漿液性網脈絡膜症（CSC）を経験したので報告する。

症例：28歳，女性。半年前から右眼の視力低下を自覚。3か月前から扁桃炎，口内炎を認めた。IgA腎症と診断され，ステロイド内服前の眼科検査目的にて当科を受診した。視力は右（0.1），左（1.5）。右眼眼底の上方から下耳側にかけて広範囲に胞状網膜剝離を認め，剝離部の網膜下全体に網膜下索状物を認めた。左眼眼底には異常を認めなかった。蛍光眼底造影検査にて右眼上耳側に複数の漏出点を認め，同部に網膜光凝固を施行した。IgA腎症の治療としては，ステロイド内服は行わず，扁桃摘出を行った。漿液性網膜剝離は徐々に吸収され，治療4か月後に完全に吸収され，再燃を認めていない。En face OCTにて黄斑部の脈絡膜血管構造を検討したところ，右眼は非対称的な血管走行を，左眼は分水嶺に対称的な血管走行を認めた。

結論：若年者の片眼に網膜下索状物を伴う網膜剝離を認めた場合，劇症型CSCとの鑑別を要する。また，劇症型CSCの片眼発症には脈絡膜血管構造の左右差が関与している可能性があると思われた。

Abstract　Purpose：To report a case of fulminant central serous chorioretinopathy（CSC）with bullous retinal detachment and extensive subretinal strands in unilateral eye of a young female.

Case：A 28-year-old woman presented with impaired visual acuity in her right eye for half a year. She has had tonsillitis and oral ulcer for 3 months. She was diagnosed with IgA nephropathy and visited our department for the purpose of ophthalmic examination before administering steroids. The best corrected visual acuity was 0.1 in the right eye and 1.5 in the left. Bullous retinal detachment was observed from the superior to the inferotemporal side of the fundus in the right eye. Subretinal strand was observed in the entire subretinal area with retinal detachment. No abnormality was found in her left fundus. Fluorescein angiography showed multiple hyperfluorescent spots in right eye. Retinal photocoagulation was performed for the leak points. Tonsillectomy was performed without oral steroids as a treatment for IgA nephropathy. Serous retinal detachment was gradually absorbed and completely disappeared 4 months after the treatment. En face OCT showed asymmetrical choroidal vessel running pattern in the right eye and symmetrical running pattern in the left eye.

Conclusions：CSC needs to be differentiated even when young women show retinal detachment with subretinal strands in one eye. In addition, left-right differences of the choroidal vascular structure of each eye may be involved in the onset of fulminant CSC in unilateral eye.