両眼に胞状網膜剝離をきたした腎性網膜症の1例

Bilateral bullous retinal detachment in a case of renal failure

目的：両眼に胞状網膜剝離が生じた腎性網膜症の症例報告。症例と経過：27歳女性が3か月前からの両眼の視力低下で受診した。3年前にネフローゼ症候群から糸球体硬化症と診断され，プレドニゾロンを8か月前まで内服していた。矯正視力は右眼0.02，左眼0.01。両眼の網膜に線状・火炎状出血，星芒状白斑，滲出，乳頭浮腫，広範な胞状網膜剝離があった。蛍光眼底造影で脈絡膜充盈欠損があり，その付近の網膜色素上皮と乳頭から色素漏出があった。腎不全，貧血，180/140mmHgの高血圧があり，血液透析を開始した。全身状態の改善に伴い網膜剝離と浮腫などが改善した。5か月後に右眼0.2，左眼0.15の矯正視力を得た。結論：重篤な胞状網膜剝離の原因として，腎不全のほか，高血圧と副腎皮質ステロイド薬の内服による網膜色素上皮障害が関与した可能性がある。

Purpose：To report a case of renal failure with bilateral bullous retinal detachment. Case and Findings：A 27-year-old woman presented with bilateral impairment of vision since 3 months before. She had had nephrosis and been diagnosed with glomerulosclerosis 3 years before. She had been treated with peroral prednisolone until 8 months before. Her corrected visual acuity was 0.02 right and 0.01 left. Both eyes showed findings of hypertensive retinopathy with bullous retinal detachment. Fluorescein angiography showed patchy dye leakage from retinal pigment epiethelium in areas of choroidal hypoperfusion. She had renal failure,anemia,and systemic hypertension. Hemodialysis was followed by prompt resolution of fundus findings and bullous detachment. She regained visual acuity of 0.2 right and 0.15 left 5 months after her initial visit. Conclusion：There is a possibility that the bullous detachment was caused by renal failure and impairment of retinal pigment epithelium due to systemic hypertension and systemic corticosteroid.