白内障を併発したmultifocal choroiditis associated with progressive subretinal fibrosisの1例

A case of multifocal choroiditis associated with progressive subretinal fibrosis complicated with cataract

　56歳女性が視力低下を主訴として受診した。矯正視力は右0.04，左0.06であった。両眼水晶体に前嚢下皮質と核に混濁があった。白内障手術の後，視力は右0.7，左0.6に改善した。前部硝子体に無色素性細胞が浮遊していた。両眼眼底に，中に白色線維増殖のある灰白色病巣があり，色素斑で囲まれていた。この病巣は，血管アーケードから赤道部にかけて分布していた。螢光眼底造影では，白色線維増殖部位は，造影早期には低螢光で，静脈相では過螢光点が出現し，次第に拡大した。黄斑下に色素貯留が生じた。以上の所見から，白内障を併発したmultifocal choroiditis associated with progressivesubretinal fibrosisと診断した。

A 56-year-old female presented with gradually deteriorating vision in both eyes. Her corrected visual acuity was 0.04 right and 0.06 left. Both eyes showed nuclear, cortical and anterior subcapsular cataract. After cataract surgery, her vision improved to 0.7 right and 0.6 left. Funduscopy showed a gray-white lesion with marked subretinal fibrosis surrounded by pigmentation in both eyes. The fundus lesion was located from the vascular arcades to the equator. Nonpigmented cells were present in the anterior vitreous. Fluorescein angiography showed hyperfluorescent spots in areas of subretinal fibrosis which showed hypofluorescence in the early phase. The hyperfluorescent spots gradually enlarged to include the whole lesion towards the late phase. The macula showed subretinal dye pooling. Systemic corticosteroid failed to improve the fundus findings. She was diagnosed as multifocal choroiditis associated with progressive subretinal fibrosis complicated with cataract.