経瞳孔温熱療法が奏効した脈絡膜血管腫の1例

Transpupillary thermotherapy was effective in a case of choroidal hemangioma

61歳男性が右眼網膜剝離で受診した。右眼の矯正視力は0.4で，乳頭鼻側の眼底に3乳頭径大の脈絡膜血管腫と，黄斑部を含む滲出性網膜剝離があった。フルオレセインとインドシアニングリーン蛍光造影で，腫瘍はびまん性過蛍光を呈した。経瞳孔温熱療法（TTT）を行い，2か月後にインドシアニングリーン蛍光造影で過蛍光が残っている部位にTTTを追加した。その後血管腫は瘢痕化し，フルオレセインとインドシアニングリーン蛍光造影所見はともに低蛍光になった。追加TTTの6か月後に網膜剝離は消失し，0.8の最終視力を得た。TTTにより血管腫内の血管が閉塞し，網膜下液が吸収されたと考えられた。滲出性網膜剝離を伴う脈絡膜血管腫に対し，TTTが奏効した症例である。

A 61-year-old man was referred to us for retinal detachment in his right eye. His corrected visual acuity was 0.4 right and 1.5 left. The right eye showed a choroidal hemangioma of 3 disc diameters in the nasal quadrant. Exudative retinal detachment was present involving the macula. The angioma showed diffuse hyperfluorescence by fluorescein and indocyanine green（ICG）angiography. The angioma was treated by transpupillary thermotherapy（TTT）. Two months later,TTT was applied to the area showing hyperfluorescence by ICG angiography. The angioma turned into scarred mass,showing hypofluorescence by fluorescein and ICG angiography. Retinal detachment disappeared 6 months after the second session of TTT,resulting in final visual acuity of 0.8. It appeared that TTT induced occlusion of vessels within the tumor and accelerated absorption of subretinal fluid. This case illustrates that TTT may be effective for chorodal hemangioma with exudative retinal detachment.