網膜色素上皮裂孔の発生過程

Course of development of tear of the retinal pigment epithelium

　経過観察中に網膜色素上皮剥離から網膜色素上皮裂孔が発生した7例7眼を経験した。3眼は網膜色素上皮下血腫を伴った滲出型加齢黄斑変性で光凝固後に生じたもの，3眼は加齢黄斑変性で自然経過中に生じたもの，1眼は多発性後極部網膜色素上皮症の自然経過中に生じたもので，いずれも大型の網膜色素上皮剥離から発生した。どの症例も裂孔は色素上皮剥離の下方の辺縁に沿って生じた。光凝固後に生じたものは，凝固部と反対側の色素上皮剥離の辺縁から生じた。多発性後極部網膜色素上皮症では，裂孔が生じる前にmicroripがみられた。

　網膜色素上皮裂孔の形成には，大きい出血性網膜色素上皮剥離や，漿液性網膜色素上皮剥離の急激な増大，網膜光凝固部の収縮性瘢痕化が原因となっていた。

We observed 7 eyes which developed tear of the retinal pigment epithelium (RPE) from previous detached RPE during the course of observation. In 3 eyes, the tear developed after laser photocoagulation for sub-RPE hematoma as complication of age-related macular degeneration (AMD) . In another 3 eyes, it developed spontaneously during the course of AMD with serous RPE detachment. In one eye, it spontaneously developed at the margin of large RPE detachment associated with multifocal posterior pigment epitheliopathy. The findings show that tear of RPE may result following large sub -RPE hematoma, rapidly enlarging RPE detachment, or laser photocoagulation resulting in RPE scarring.