網膜剝離を合併した朝顔症候群の1例

Retinal detachment in an eye with morning glory syndrome

要約　14歳男児の右眼に扁平な網膜剝離が発症した。右眼は生後8か月のときに朝顔症候群と診断されていた。左眼は正常であった。右眼に硝子体手術を行い，朝顔状の乳頭内に裂孔を確認した。網膜剝離は再発を繰り返し，4回目の硝子体手術の際に裂孔の閉鎖が確認できたにもかかわらず，胞状の剝離が再発し，右眼は失明した。朝顔症候群に合併した網膜剝離の原因は，朝顔部の網膜裂孔と，視神経を介してのクモ膜下腔から網膜下への髄液の流入があると推定される。このような網膜剝離には，裂孔を閉鎖せずに乳頭周囲の網膜を眼球壁に固定する方法か，裂孔を閉鎖してクモ膜下腔と網膜下腔との連絡を遮断する方法があると判断した。

Abstract.　Flat retinal detachment developed in the right eye of a 14-year-old boy. The right eye had been diagnosed with morning glory syndrome at the age of 8 months. His left eye was normal. A retinal break was detected in the disc area during vitrectomy. Retinal detachment recurred after repeated surgeries. Although the retinal break was found to have closed during the last and fourth vitreous surgery,the eye became blind due to bullous retinal detachment. There are two possibilities in the cause of retinal detachment secondary to morning glory syndrome. One is due to retinal break in the disc area. The other is due to inflow of cerebrospinal fluid into the subretinal space. Surgery may be performed to attach the detached retina to the inner eyewall without closure of retinal break. As an alternative,surgery may be performed to block entrance of subarachnoid fluid into the subretinal space by closing the retinal break in the disc area.