急性後部多発性斑状色素上皮症の治療中に脈絡膜構造変化の経過を追えた1症例

Chronological changes in choroidal structure in cases of acute posterior multifocal placoid pigment epitheliopathy

要約　目的：急性後部多発性斑状色素上皮症（APMPPE）の脈絡膜構造変化を経時的に観察した1例を報告すること。

症例：61歳，女性。左眼の変視症を主訴に鹿児島大学病院眼科を紹介され受診した。初診時視力は左右ともに（1.0）であった。両眼とも前眼部，硝子体内に炎症所見を認めず，左眼のみ後極部に黄白色の斑状病変を網膜色素上皮レベルに認めた。光干渉断層計では，左眼黄斑部に網膜下液と脈絡膜の肥厚，網膜色素上皮ラインの波うちを認めた。造影検査の結果も併せてAPMPPEと診断し0.1％ベタメタゾン点眼を開始した。治療開始後2週間で漿液性網膜剝離は消失，1か月後には黄白色の網膜色素上皮レベルの斑状病変は消失し，歪視も改善した。

結果：患眼の中心窩下脈絡膜厚は初診時とその1，3か月目で，650μm，351μm，165μmであり，時間とともに減少した。また急性期では脈絡膜間質成分の割合が増加し，経過とともに管腔/間質比が2.03から2.40へと増大した。

結論：APMPPEの診断と経過観察に中心窩下脈絡膜厚や脈絡膜構造変化は有用である可能性がある。

Abstract　Purpose：To report a case of acute posterior multifocal placoid pigment epitheliopathy（APMPPE）with longitudinal choroidal structural changes.

Case：A 61-year-old woman was referred to our department with a complaint of heterophoria of the left eye. Her best collected visual acuity was 1.0 in both eyes at the initial visit. Although there was no inflammation in the anterior chamber or vitreous of both eyes, a yellowish-white macular lesions at the level of the retinal pigment epithelium was seen in the posterior pole of the left eye. Optical coherence tomography showed serous retinal detachment in the macula of the left eye, thickening of the choroid, and undulation of the retinal pigment epithelium. Considering these finding together with the those of angiography, she was diagnosed with APMPPE, and treatment with 0.1％ betamethasone ophthalmic drops was initiated. Two weeks after starting treatment, the serous retinal detachment disappeared, and one month later, the yellowish-white macular lesions disappeared and the distorted vision improved.

Results：The subfoveal choroidal thickness of the diseased eyes decreased from 650 μm, 351 μm, and 165 μm at the initial visit, at the first and third months, respectively. The ratio of choroidal interstitial component increased in the acute phase, and the luminal/interstitial ratio increased over time.

Conclusion：The subfoveal choroidal thickness and choroidal structure changed over time in APMPPE.