放射線療法が奏効した転移性脈絡膜腫瘍のインドシアニングリーン蛍光眼底造影所見

Indocyanine green angiographic features in a patient of metastatic choroidal tumor with favorable response to radiation therapy

（R1-9AM-12）　53歳の女性が左眼の霧視で受診した。42か月前に両側の乳癌手術を受け，6か月前に胸膜転移が発症した。右眼に6乳頭径大，左眼に4乳頭径大の黄白色隆起性腫瘤があり，いずれにも漿液性網膜剥離が併発していた右眼ではこの他に2乳頭径大の腫瘤を2か所認めた。乳癌の脈絡膜転移と診断した。総線量40Gyの放射線照射後，腫瘍は平坦化し，網膜剥離は消失した。照射終了9日後のフルオレセイン蛍光眼底造影（FA）では，造影初期にあった腫瘍部の低蛍光領域が減少し，後期の色素漏出はほぼ消失した。照射終了1か月後のインドシアニングリーン蛍光眼底造影（lA）では，治療前に腫瘍でブロックされていた脈絡膜血管が造影初期から観察され，治療前の造影後期にあった腫瘍の辺縁部の輪状過蛍光が消失した。FAは網膜色素上皮の障害と修復，lAは治療後の腫瘍の消失と脈絡膜の血流改善を知るのに有用であることを示す所見である。

A 53-year-old female presented with blurring of vision in her left eye. She had undergone resection of bilateral breast carcinoma 42 months before. Pleural metastasis had developed 6 months before. A yellowish elevated tumor accompanied by serous retinal detachment was present in both eyes. Its size was 6 disc diameters (DD) right and 4 DD left. There were two others besides right. She was diagnosed as metastatic choroidal carcinoma. Radiation totalling 40 Gy induced flattening of the tumor and disappearance of retinal detachment. Fluorescein angiography (FA) showed decreased hypofluorescence in the tumor area and cessation of dye leakage. Indocyanine green angiography (IA) showed choroidal vessels from the early angiographic phase on which had been blocked by the tumor mass initially. Late-phase hyperfluorescent halo surrounding the tumor disappeared also. The findings show that FA is of value in assessing the damage and repair of the retinal pigment epithelium and that IA reflects the course of regression of the tumor and improved state of choroidal circulation.