網膜色素変性症に黄斑部牽引性網膜剥離を合併した1症例

Tractional detachment of the macula in a case of retinitis pigmentosa

　網膜色素変性症に後部ぶどう腫，黄斑前膜，牽引性網膜剥離を合併した1例を経験した。51歳男性で，右眼の黄斑部から血管アーケードおよび後部ぶどう腫の辺縁にかけて黄斑前膜がみられ，黄斑部から上方の後部ぶどう腫の辺縁にかけて牽引性網膜剥離が進行してきたため硝子体手術を行い，黄斑前膜除去，人工的後部硝子体剥離作成，ガスタンポナーデにより網膜の復位を得た。術中所見では，肥厚した後部硝子体膜が網膜と強固に癒着して黄斑前膜と連続していた。黄斑前膜および後部硝子体膜の収縮により後部ぶどう腫内で生じる網膜接線方向の牽引が，本症例における牽引性網膜剥離の原因と推測された。

A 51-year-old male presented with metamorphopsia in his right eye of recent onset. He had high myopia and night blindness since childhood. He had been diagnosed as retinitis pigmentosa about 30 years before. His corrected visual acuity was 0.05 right and 0.02 left. Funduscopy showed posterior staphyloma and typical features of retinitis pigmentosa. The right eye showed macular pucker at the margin of posterior staphyloma with tractional retinal detachment involving the macula. The retina could be reattached following vitrectomy with membrane peeling, arteficial detachment of the posterior vitreous and gas tamponade. As intraoperative finding, a thick posterior vitreous membrane was adherent to the retina including the macula, inducing tangential traction and retinal detachment.