沈下型蛍光漏出を示す胞状網膜剥離の臨床的特徴

Clinical characteristics of bullous retinal detachment manifesting inferiorly-directed smokestack phenomenon

　特発性漿液性網膜剥離のうち，フルオレセイン蛍光造影で網膜色素上皮からの蛍光漏出が下方に向かう症例の特徴を検索した。沈下型蛍光漏出は，胞状網膜剥離69例115眼のうち8例8眼（7％）にあり，典型的な中心性網脈絡膜症630例840眼ではこれがなかった。沈下型蛍光漏出は，全例で網膜色素上皮剥離の縁から始まっており，漏出液の周囲には網膜下の滲出斑（白色斑紋）があった。7眼では白色斑紋の中に網膜下液の通路に一致して，淡く透明な部位があった。蛍光漏出が下方に向かい，周囲に白色斑紋を伴う現象は，漏出液が蛋白などの成分に富み，網膜下液よりも比重が大きいためと推定した。

We reviewed cases of idiopathic serous retinal detachment that manifest inferiorly-directed smokestack phenomenon by fluorescein angiography. This finding was present in 8 eyes of 8 cases (8%) in 115 eyes of 69 cases of bullous retinal detachment. It was absent in 840 eyes of 630 cases of classic central serous chorioretinopathy. The inferiorly-directed dye leakage started at the edge of detachment of retinal pigment epithelium in all the 8 eyes. A white halo was present around the site of dye leakage. A transparent area was present within the white halo corresponding to the site of dye leakage in 7 of 8 eyes. The inferiorly-directed dye leakage associated with white halo appeared to indicate that the transudate entering the subretinal space was rich in protein content with a higher density than the subretinal fluid.