悪性リンパ腫関連網膜症の1例

A case of lymphoma-associated retinopathy

要約　目的：視力と視野障害で初発し，18か月後に頭蓋内悪性リンパ腫が発症した症例の報告。症例：68歳男性が8か月前からの両眼の霧視と光視症で受診した。4か月前の矯正視力は右0.5，左0.3であり，ステロイド薬の全身投与により一時的な改善がみられたもののその後は抵抗性となった。所見：矯正視力は右0.06，左1.0で，右眼に中心暗点，左眼に視野狭窄があった。網膜電図でa・b波が減弱し，蛍光眼底造影で網膜血管からのびまん性漏出があった。その10か月後に意識障害と片麻痺が生じ，頭蓋内悪性リンパ腫と診断された。さらに5か月後の最終診察時の視力は右0.1，左0.2で，光干渉断層計（OCT）で網膜外層の菲薄化があった。結論：臨床所見と経過から，本症例は悪性リンパ腫に関連した網膜症であると推定される。

Abstract.　Purpose：To report a case who showed impaired visual acuity and field defect as the initial manifestation and who was diagnosed with intracranial malignant lymphoma 18 months later. Case：A 68-year-old male was referred to us for bilateral photopsia and blurring since 8 months before. The visual acuity was reportedly 0.5 right and 0.3 left 4 months before. The ocular symptoms had not improved after systemic prednisolone therapy. Findings：Corrected visual acuity was 0.06 right and 1.0 left. Central scotoma was present in the right eye and visual field constriction in the left eye. Electroretinogram showed decreased a and b waves in both eyes. Fluorescein angiography showed diffuse dye leakage from retinal vessels. He developed hemiplegia with impaired consciousness 10 months later. He was diagnosed with intracranial malignant lymphoma. Optical coherence tomography showed attenuated outer retinal layers. Conclusion：Ocular manifestations in this case are compatible with the diagnosis of lymphoma-associated retinopathy.