発症直後から瘢痕治癒過程まで観察した外傷性網脈絡膜断裂の1例

A case of traumatic retinochoroidal rupture observed from onset to the scar healing process

要約　目的：眼球打撲により広範な網脈絡膜断裂をきたした症例に対し，多機能広角眼底撮影装置を用いて経時的に眼底を後極から周辺部まで詳細に撮影し，経過観察できたので報告する。

症例：29歳，女性。正面から顔面を殴打され受傷した。左眼瞼の高度腫脹を認めるが，中間透光体は清明であった。眼底は，左眼は視神経乳頭内下方に一象限を超える広範な網脈絡膜断裂および出血を認め，強膜の露出を認めた。明らかな網膜剝離は認めず，後部硝子体剝離も起きていなかった。

結果：硝子体出血は限局的で，網脈絡膜断裂はあるものの網膜剝離を認めなかったことから，経過観察を行った。光干渉断層計では，裂孔周囲に網膜剝離や脈絡膜新生血管は認めず，網脈絡膜断裂部に架橋的に緩徐なグリオーシスによる線維化を生じた。経過中，網膜上や硝子体への増殖性変化は認めず，保存的に経過観察可能であった。広角眼底撮影装置でも周辺部網膜まで経時的に撮影記録を行ったが，新たな裂孔などは認めなかった。

結論：後部硝子体未剝離症例に外傷性に一象限を超える広範な網脈絡膜断裂を起こした症例を経験し，保存的に経過をみた。多機能広角眼底撮影装置は経時的に後極から周辺部網膜まで詳細に観察が可能で，経過観察や治療方針決定に有用であった。

Abstract　Purpose：We report a case of periocular invasion and extensive retinochoroidal rupture due to an ocular contusion, which was observed using a multifunctional wide-angle fundus imaging system that allowed detailed imaging from the posterior pole to the periphery of the fundus over time.

Case：The patient was a 29-year-old woman with injuries from a frontal blow to the face. An extensive retinochoroidal rupture and hemorrhage over one retinal quadrant was observed around the optic nerve head, and the sclera was exposed to the vitreous space. There was no obvious retinal detachment and no posterior vitreous detachment had occurred.

Result：Since the vitreous hemorrhage was localized and no retinal detachment was observed, the patient was followed up under careful observation. Optical coherence tomography showed no retinal detachment or choroidal neovascularization around the rupture and bridging fibrosis at the retinochoroidal rupture. During the course of the disease, there was no signs of proliferative vitreoretinopathy throughout the observation period, and the patient was followed up conservatively. Wide-field scanning laser ophthalmoscopy clearly visualized detailed changes of the retina and choroid and was very rapid and effective for high-resolution imaging.

Conclusion：Due to the undetached posterior vitreous, the extensive traumatic retinochoroidal rupture over one retinal quadrant was conservatively followed up without retinal detachment or proliferative vitreoretinopathy. Wide-field scanning ophthalmoscope with spectral-domain optical coherent tomography successfully provided clear and detailed observation.