裂孔原性網膜剝離術後に後極部に多発性の孤立性網膜斑状病変を生じた1例

A case of multiple solitary patches in the posterior fundus following surgery for rhegmatogenous retinal detachment

要約　目的：網膜剝離手術後に多発性斑状病変が後極部眼底に生じた症例の報告。症例：53歳女性が前日からの右眼視力低下で受診した。右眼矯正視力は0.2で，眼底の外上方に円孔があり，黄斑を含む網膜剝離があった。経過：眼球の外半周にシリコーンスポンジを縫着し，網膜下液の排液と冷凍凝固を行った。網膜は復位し，矯正視力は0.8に改善した。手術の1か月後に後極部から赤道一帯に境界鮮明な黄白色斑が多発し，その範囲は術前の網膜剝離のそれと一致した。黄白色斑の部位はフルオレセイン蛍光造影で過蛍光を呈し，光干渉断層検査（OCT）でこれに相当して孤立性網膜剝離があった。以後無治療で眼底所見は寛解し，6か月後に視力は1.5になった。結論：網膜剝離の術後に孤立性斑状病変が眼底に生じることがあり，網脈絡膜循環障害ないし網膜色素上皮障害が関与している可能性がある。

Abstract.　Purpose：To report a case of rhegmatogenous retinal detachment with multiple patches in the fundus after surgery. Case：A 53-year-old female presented with blurring in her right eye since the previous day. Corrected visual acuity was 0.2 right. The right eye showed retinal detachment extending from the macula to the superior temporal periphery where a retinal hole was located. Clinical Course：The right eye received surgery by applying a silicone sponge along the temporal equator, aspiration of subretinal fluid, and cryocoagulation. The retina became reattached with improved visual acuity. One month after surgery, numerous yellowish-white patches appeared at the previous site of retinal detachment. These patches showed hyperfluorescence by fluorescein angiography and showed focal retinal detachments by optical coherence tomography（OCT）. Spontaneous recovery set in with visual acuity improving to 1.5 6 months later. Conclusion：Multiple fundus patches may appear after surgery for retinal detachment, possibly due to disturbance in chorioretinal circulation or retinal pigment epithelium.