経強膜的腫瘍切除術を行った脈絡膜悪性黒色腫の1例

A case of choroidal malignant melanoma treated by transscleral resection

　眼球摘出術を拒絶した左眼脈絡膜悪性黒色腫患者に対し，経強膜的腫瘍切除摘出術（eyewall resection）を施行し，視機能の保存に成功した本邦第2例目の症例について報告した。症例は，左眼の下方視野狭窄を主訴に来院した55歳の女性で，初診時の視力はR．V．=0.4（0.7），L．V．=0.05（0.6）であった。左眼眼底上耳側，赤道部に1象限に及ぶ，色素沈着を伴う半球状の隆起性病変を認め，大きさは超音波検査にて，径10.8mm×12.4mmにおよんだ。手術は，ジアテルミー凝固術にて腫瘍周囲をマーク後，強膜を半層切開，残存側の強膜と腫瘍をen blocに切除し，切除標本の病理組織像は，mixed cell typeの悪性黒色腫であった。術後の出血とPVRに対して硝子体手術が有効であり，網膜を復位し得た。術後144日の同眼の矯正視力は0.05p，眼圧は6mmHgであり，遠隔転移は見いだされていない。

A 55-year-old woman presented with visual field defect in the left eye. Funduscopy showed a large pigmented tumor occupying the superior temporal quadrant. It measured 10.8 mm x 1.2 mm by ultrasonography. We attempted resection of the tumor after the patient refused enucleation. After marking the margin of the tumor by penetrating diathermy and forming a half-thickness scleralflap, the tumor was resected en bloc together with the scleral and retinal portions. The postoperative retinal detachment and vitreous hemorrhage were treated by vitrectomy. Her visual acuity was 20/400 5 months after surgery. Histopathology of the resected tumor showed malignant melanoma of mixed cell type. There has been no sign of metas-tasis so far.