Purtscher網膜症の網膜断層像の経過

Longitudinal course of a case of Purtscher retinopathy observed by optical coherence tomography

要約　目的：光干渉断層計（OCT）で経過を追ったPurtscher網膜症の1例の報告。症例：70歳男性が自動車を運転中に電柱に衝突し，多発性肋骨骨折を生じ，その翌日に受診した。矯正視力は右0.2，左0.02で，両眼の乳頭周囲に綿花様白斑があり，左眼は乳頭黄斑間に網膜の白濁があった。OCTで両眼に漿液性網膜剝離と左眼網膜内層に高反射があった。漿液性網膜剝離は1か月後に消失した。受傷から3か月後に矯正視力は右1.0，左0.7になったが，白濁部では網膜内層が菲薄化し，視細胞の内節と外節の接合部が消失し中心暗点が生じた。結論：Purtscher網膜症の急性期では網膜の白濁と綿花様白斑が混在し，漿液性網膜剝離があった。陳旧期では網膜内層が菲薄化し，視細胞の内節と外節の接合部が消失し，中心暗点の原因になった。

Abstract.　Purpose：To report changes in optical coherence tomographic findings of a case of Purtscher retinopathy. Case：A 70-year-old male suffered a traffic accident resulting in multiple fractures of the ribs. When seen the following day, his corrected visual acuity was 0.2 right and 0.02 left. Both eyes showed cotton-wool patches around the optic disc. The left eye showed retinal opacity in the papillomacular area. Optic coherence tomography（OCT）showed serous retinal detachment in both eyes and highly refractive inner retinal layer. Retinal detachment disappeared one month later. The visual acuity recovered to 1.0 right and 0.7 left 3 months after injury. OCT showed attenuated inner retinal layer and disappearance of junction line between the inner and outer segment of visual cells corresponding to area of central scotoma. Conclusion：In this case of Purtscher retinopathy, retinal opacity and cotton-wool patches with serous retinal detachment were major retinal findings in the acute phase. In the protracted stage, inner retinal layer became attenuated with disappearance of junction line between the inner and outer segment of visual cells in the area corresponding to central scotoma.