網膜細動脈瘤破裂に伴う黄斑円孔が自然閉鎖した1症例

Spontaneous closure of macular hole associated with retinal arterial macroaneurysm rupture

要約　目的：網膜細動脈瘤（RAM）破裂に伴う黄斑円孔が自然閉鎖した1例を報告する。

症例：91歳，女性。1週間前からの両眼視力低下を主訴に他院を受診し，右眼に網膜下出血，左眼に硝子体出血を認めたため，8日後に東京都健康長寿医療センター眼科を紹介され受診となった。

所見：矯正視力は右0.08，左光覚なしであった。眼底は右眼に軽度の硝子体出血と黄斑部耳下側にRAMを認め，その周囲に軽度の内境界膜（ILM）下出血と網膜下出血を認めた。左眼は硝子体出血のため透見不良であった。光干渉断層計では右眼の黄斑部のILM下出血は吸収されており，硝子体側に凸状に剝離したILM，その下に黄斑円孔を認めた。既往歴は無治療の高血圧症のみであった。右眼は円孔径が小さく，黄斑円孔がILMに被覆される可能性があることから自然閉鎖を期待し経過観察とし，左眼は白内障および硝子体手術を施行したが，網膜動静脈の白線化と視神経萎縮を認め，術後も視力は光覚弁であった。受診後1か月の時点で右眼の円孔は閉鎖し，視力は矯正視力0.2に改善，その後白内障手術も施行し受診後5か月で0.5p（矯正不能）まで改善した。

結論：RAM破裂に伴う黄斑円孔は，自然閉鎖する可能性が示唆された。

Abstract　Purpose：We report a case of spontaneous closure of a macular hole associated with rupture of retinal arterial microaneurysm.

Case：A 91-year-old woman visited a local clinic with decreased binocular vision that developed 1 week prior. Sub-inner limiting membrane（ILM）hemorrhage in her right eye and vitreous hemorrhage in her left eye were found. Therefore, she was referred to our hospital 8 days later.

Corrected visual acuity of her right eye was 0.08 and left eye was no light perception in the left eye. In the fundus of right eye, mild vitreous hemorrhage and retinal arterial microaneurysm（RAM）on the temporal side of the macula and mild sub-ILM hemorrhage and subretinal hemorrhage were found. Her left eye had poor transparency due to vitreous hemorrhage. Optical coherence tomography（OCT）revealed the absorption of sub-ILM hemorrhage, convex extension of ILM to the vitreous side, and a macular hole. Her medical history induded untreated hypertension.

Since the macular hole had a small diameter and was covered by the ILM, it was expected to close spontaneously. For the left eye, we performed cataract and vitreous surgery. Retinal arteriovenous whitening and a optic atrophy were observed with postoperative light perception. One month after the first consultation, the macular hole of her right eye had closed spontaneously and the corrected visual acuity improved to 0.2, following which the cataract surgery was performed. The visual acuity improved to 0.5p（uncorrectable）5 months after the first consultation.

Conclusions：These findings suggest that a macular hole associated with rupture of retinal arterial microaneurysm may close spontaneously.