混合性結合組織病に合併した多発性後極部網膜色素上皮症の1例

Multifocal posterior pigment epitheliopathy in a case of mixed connective tissue disease

（26C-11）　混合性結合組織病に合併した多発性後極部網膜色素上皮症の1例を経験した。症例は36歳の女性で，混合性結合組織病のためステロイド投与中に両眼底後極部に扁平な漿液性網膜剥離を生じ，ステロイド大量療法を開始したところ，両眼の眼底広範囲に多発性の黄白色滲出斑が出現し，体位により移動する胞状網膜剥離を伴った。螢光眼底造影検査では滲出斑に一致して両眼とも多数の漏出点がみられ，脈絡膜背景螢光の流入も遅延していた。発症時には血中のトロンビン-アンチトロンビンIII複合体が上昇しており，本症例の発症には血液凝固能の亢進による脈絡膜循環不全が関与していたと考えられた。またステロイドは本症例の増悪因子として働いたと考えられた。

A 36-year-old female presented with serous retinal detachment in the posterior fundus in both eyes. She had been under treatment with oral corticosteroid for mixed connective tissue disease since 17 months before. She showed elevated thrombin-antithrombin complex in the serum. Eight days after start of massive corticosteroid therapy, numerous yellow exudative lesions developed in both eyes associated with bullous retinal detachment. Fluorescein angiography showed numerous points of dye leakage from the choroid at the sites of exudates. Areas of delayed dye filling of the choriocapillaris were also present. It appeared that the fundus lesion was induced by impaired choroidal circulation due to elevated blood coagulability and was triggered by sustained systemic corticosteroid. Photocoagulation to the sites of dye leakage resulted in rapid resolution of retinal detachment.