硝子体手術と術中汎網膜光凝固で網膜復位と虹彩新生血管の消退を得た成人Coats病の1例

Successful treatment of Coats disease with retinal detachment and rubeosis iridis in an adult by vitrectomy and endophotocoagulation

　61歳女性が左眼視力障害で受診した。6年前に眼底出血と広範な網膜滲出斑が発見された。矯正視力は1.5であったが当科受診時には0.1に低下していた。左眼虹彩に新生血管，後極部眼底に多量の網膜下滲出物と索状物，滲出性網膜剥離，周辺部網膜に血管拡張と牽引性網膜剥離があった。成人性Coats病と診断した。硝子体手術で網膜を復位させ，術中に汎網膜光凝固を行った。術後，滲出性網膜剥離はほとんど消失し，虹彩新生血管は消退した。以後15か月間，再発はない。硝子体手術による網膜復位と術中汎網膜光凝固が，牽引性網膜剥離などのために経瞳孔的網膜光凝固が不可能なCoats病に奏効した症例である。

A 61-year-old female presented with visual impairment in her left eye. She had been found with retinal hemorrhage and extensive subretinal exudation with full visual acuity 6 years before. Her corrected visual acuity was 0.1 when seen by us. Her left eye showed rubeosis iridis, exudative retinal detachment, and telangiectasis and vitreous traction in the peripheral retina. She was diagnosed with adult-type Coats disease. The retina became reattached following vitrectomy, membrane delamination, fluid-gas exchange, and panretinal endo-photocoagulation. Rubeosis iridis disappeared also. She has been doing well during 15 months after surgery. This case illustrates that vitrectomy with endophotocoagulation may be effective for advanced Coats disease.