乳頭小窩黄斑症候群に対してinverted ILM flap併用硝子体手術が有効であった1例

A case of effective vitrectomy with inverted ILM flap method for pit-macular syndrome

要約　目的：乳頭小窩黄斑症候群に対してILM invert flap併用硝子体手術が有効であった症例の報告。

症例：患者は40歳台の女性で，左眼の視力低下で当院を紹介され受診した。20年前から左眼のコロボーマを指摘され，当初の矯正視力は左眼0.6であった。

所見と経過：初診時の矯正視力は右1.2，左0.2で，両眼の前眼部および中間透光体に異常はなかった。左眼の眼底の乳頭耳側に乳頭小窩およびコロボーマを認めた。光干渉断層計（OCT）で視神経乳頭耳側から黄斑部にかけて漿液性網膜剝離を認めた。硝子体手術を施行し人工的に後部硝子体剝離を作成した。乳頭耳側の内境界膜を剝離し，乳頭縁で翻転して小窩を被覆し，空気タンポナーデを施行した。術後，OCTにて乳頭小窩上に内境界膜が確認された。また早期より黄斑部の漿液性網膜剝離の著明な減少を認め，視力も術後1か月で0.4まで改善を認めた。術後半年で，OCTにて乳頭小窩耳側から黄斑部にかけての漿液性網膜剝離は減少しており，視力は0.5まで改善した。

結論：乳頭小窩黄斑症候群に対してILM invert flap併用硝子体手術が有効であったことを本症例は示している。

Abstract　Purpose：To report a case in which internal limiting membrane（ILM）translocation was effective in treating papillary foveal macular syndrome.

Case：A woman in her 40s was referred to our office because of decreased vision in her left eye. Twenty years earlier, she had been diagnosed with coloboma of the left eye；initial visual acuity was 1.0 in the left eye.

Findings and progress：At the time of initial examination, corrected visual acuity was 1.2 in the right and 0.2 in the left eye, and there were no abnormalities in the anterior or intermediate translucent areas of either eye. A pit and coloboma were observed on the left fundus on the apex of the papilla. Optical coherence tomography（OCT）showed serous detachment of the macula. Vitrectomy was performed, an artificial posterior vitreous detachment was created, and the ILM on the auricular side of the papilla was detached and flipped at the papillary margin for insertion into the papillary pit, where air tamponade was performed. Postoperatively, OCT showed the ILM encroaching into the pit site. In addition, a marked decrease in serous detachment of the macular area was observed early on, and visual acuity improved to 0.4 at one month after surgery. Six months after surgery, OCT showed that the serous detachment from the pit to the subretinal area and macular area had disappeared, and visual acuity improved from 0.2 to 0.6.

Conclusion：This case demonstrates that vitrectomy with inverted ILM flap method was effective in treating papillary foveal macular syndrome.