白内障術後に多発性後極部網膜色素上皮症をきたした1例

A case of multifocal posterior pigment epitheliopathy following cataract surgery

　46歳の男性を，両眼水晶体亜脱臼にて経過観察していたが，徐々に右眼水晶体偏位が強くなり，1999年4月19日に，右眼水晶体嚢内摘出術および眼内レンズ毛様溝縫着術を行った。術前眼底は異常なく術中合併症もなかったが，術後4日目に右眼後極部に漿液性網膜剥離と色素上皮剥離を認めた。フルオレセイン蛍光眼底造影では両眼に多発性の過蛍光がみられ，多発性後極部網膜色素上皮症（MPPE）と診断した。蛍光漏出点に対して光凝固を行い，漿液性網膜剥離と色素上皮剥離は消失した。インドシアニングリーン蛍光眼底造影では両眼の脈絡膜の循環障害がみられた。本症例は白内障手術による直接的，間接的ストレスが誘因となり，脈絡膜の一過性虚血が生じ，MPPEが発症したと考えた。

A 46-year-old man had longstanding subluxation of the lens in both eyes. Funduscopic findings were normal. He underwent uneventful intracapsular lens extraction with transsclerally sutured intraocular lens implantation in his right eye. Four days after surgery, the right eye developed serous retinal detachment with retinal pigment epithelial detachment in the posterior fundus. Fluorescein angiography showed multiple hyperfluorescent spots during the early phase and dye pooling in the late phase in both eyes. The findings were suggestive of multifocal posterior pigment epitheliopathy, MPPE. Indocyanine green angiography showed disturbed choroidal circulation in both eyes. Laser photocoagulation to the spots of dye leakage induced cure of the retinal detachment and retinal pigment epithelial detachment. It appeared that the MPPE was induced by temporary choroidal ischemia secondary to stress of eye surgery.