インドシアニングリーン螢光眼底造影を施行した白血病性網膜症の1例

Indocyanine green angiographic findings in a case of leukemic retinopathy

　慢性骨髄性白血病の19歳男性の両眼に，乳頭浮腫，網膜静脈の拡張蛇行，Roth斑を伴う網膜出血があった。フルオレセイン螢光眼底造影で，乳頭の螢光染と周辺部眼底の色素上皮障害部位に一致して過螢光斑があった。インドシアニングリーン（ICG）螢光眼底造影で，造影初期から周辺部眼底に過螢光点が多発し，色素上皮の障害部位には低螢光斑があった。造影後期には，検眼鏡的またはフルオレセイン螢光眼底造影で異常がない部位に小円形の低螢光部が出現した。治療による眼底所見の改善とともに，ICG螢光眼底造影では，低螢光斑の縮小，過螢光点の数の減少，小円形の低螢光部の消失があった。ICG螢光眼底造影で見られたこれらの所見は，白血病細胞の浸潤による脈絡膜の病的変化を反映していると考えられた。

A 22-year-old male with chronic myelogenous leukemia manifested, bilaterally, papilledma,engorgement and tortuousity of retinal veins, and retinal hemorrhages associated with white patches (Roth's spots). Fluorescein angiography showed dye staining of the optic disc and hyperfluorescent patches in the peripheral fundus. Indocyanine green (ICG) angiography showed, during the early phase, hyperfluorescent dots in the peripheral fundus and hypofluorescent patches corresponding to areas of damaged retinal pigment epithelium. Late-phase ICG angiography showed small round hypofluorescent patches in areas which appeared normal by funduscopy of fluorescein angiography. After improvement in fundus findings due to treatment, ICG angiography showed decrease in the size of hypofluorescent patches, decreased number of hyperfluorescent dots and disappearance of small round hypofluorescent patches. The observed ICG angio-graphic features seemed to reflect pathological changes in the choroid induced by infiltrated leukemic cells.