照射エネルギー減量光線力学的療法後30か月安定した多発性後極部網膜色素上皮症の1例

The 30-month preferable outcome in a case of multifocal posterior pigment epitheliopathy after reduced-fluence photodynamic therapy

要約　緒言：高度な漿液性網膜剝離を伴った多発性後極部網膜色素上皮症（MPPE）に対して照射エネルギー減量光線力学的療法（RF-PDT）後に長期間安定した1例を経験したので報告する。

症例：63歳，男性。IgA腎症に対して2018年5月よりステロイド投与されていた。2018年10月頃より右視力低下を自覚し，同年11月に近医で網膜剝離を指摘されて当科に紹介された。初診時視力は右（0.7），左（0.9）で，黄斑部から耳下側にかけて網膜皺襞を伴う広範な漿液性網膜剝離を認めた。フルオレセイン蛍光眼底造影で黄斑部下方および耳側の網膜色素上皮病変から著明な蛍光漏出を認めた。MPPEと診断し，RF-PDTを1回行った。PDT後3か月で網膜剝離は一部を残し消失した。PDT後12か月の造影検査では脈絡膜血管透過性亢進を認めるものの滲出性変化はなく，その後も30か月時点まで再発はみられず，最終視力は右（0.9）まで改善した。

結論：高度な漿液性網膜剝離を伴うMPPEに対してRF-PDTは長期間にわたり有効な治療であった。

Abstract　Purpose：To report a case of multifocal posterior pigment epitheliopathy（MPPE）with severe serous retinal detachment that showed preferable outcomes for a long time after reduced-fluence photodynamic therapy（RF-PDT）.

Case：A 63-year-old male had been taking steroids for IgA nephropathy since May 2018. In October 2018, he experienced vision loss in his right eye and he was referred to our department the next month. At initial visit, his visual acuity was（0.7）in the right eye and（0.9）in the left eye, and an extensive serous retinal detachment with a retinal wrinkle wall was observed from the macula to the temporal lower area. Fluorescein angiography（FA）showed marked leakage from the pigment epithelial lesions at the lower and temporal sides of the macula. He was diagnosed with MPPE, and a single RF-PDT was performed in his right eye. Three months after PDT, the serous retinal detachment was mostly resolved. One year after PDT, choroidal vascular hyperpermeability remained, but there was no exudative change, and no recurrence was observed until 30 months thereafter, and the final visual acuity was（0.9）in the right eye.

Conclusion：RF-PDT may be an effective long-term treatment option for MPPE cases with severe serous retinal detachment.