網膜血管腫に伴う硝子体出血と黄斑上膜に対して硝子体手術を行った1例

A case of retinal hemangioma treated by vitrectomy for vitreous hemorrhage and epimacular membrane

要約　目的：硝子体出血に対して硝子体手術を行い，網膜血管腫が発見された症例の報告。症例と所見：71歳女性が8か月前からの右眼の霧視で受診した。矯正視力は右指数弁，左1.5で，右眼に強い硝子体出血があった。超音波検査で後部硝子体剝離と，下鼻側の眼底に隆起性病変があった。硝子体手術の術中所見として，乳頭の下方に約5乳頭径大の網膜血管腫と思われる腫瘤と，流入・流出血管があり，これから黄斑部にかけて網膜剝離と網膜上膜があった。網膜上膜を剝離し，網膜血管腫に冷凍凝固を行い，流入血管を光凝固した。術後さらに光凝固を追加した。7か月後に0.2の視力が得られた。網膜血管腫と関係する全身の異常はなかった。結論：本症例は後天性の網膜血管腫に続発した硝子体出血と推定される。硝子体手術と術中・術後の光凝固が有効であった。

Abstract.　Purpose：To report a case of retinal hemangioma diagnosed after vitreous surgery for vitreous hemorrhage. Case and Findings：A 71-year-old woman presented with blurred vision in her right eye since 8 months before. Corrected visual acuity was counting fingers right and 1.5 left. The right eye showed dense vitreous hemorrhage. Echography showed posterior vitreous detachment and an elevated lesion in the lower-nasal quadrant. A retinal hemangioma was detected during vitrectomy. It was 5 disc diameters across and had feeder and drainage vessels. Retinal detachment was present involving the macula. Epimacular membrane was also present and was removed. Cryocoagulation was applied to the hemangioma. Feeder and drainage vessels were photocoagulated. Visual acuity recovered to 0.2 7 months after surgery. She was free of systemic lesions associated with retinal hemangioma. Conclusion：She was diagnosed with acquired retinal hemangioma. Victrectomy and photocoagulation were useful means of treatment.