高度の黄斑浮腫を伴う網膜細動脈瘤の経過中に脈絡膜新生血管を生じた1例

Choroidal neovascularization in a case of retinal arterial macroaneurysm with severe macular edema

要約　目的：網膜細動脈瘤による黄斑浮腫が遷延し，脈絡膜新生血管（CNV）が生じた症例の報告。症例：78歳女性が9か月前からの緩慢な右眼視力低下で受診した。軽度の高血圧と糖尿病があった。所見：矯正視力は右0.2，左0.9で，右眼網膜の下耳側動脈に白色の瘤があり，黄斑に及ぶ硬性白斑と浮腫があった。黄斑浮腫は光干渉断層計でも確認された。滲出型網膜細動脈瘤と診断し，血管瘤を光凝固した。4か月後に再度の光凝固を行い，その1か月後に黄斑下に出血が生じ，視力は0.02に低下した。初診から7か月後に灰白色病巣が生じ蛍光眼底造影で2乳頭径大のCNVがあった。抗血管内皮増殖因子抗体を硝子体内に投与した。その7か月後，CNVと網膜細動脈瘤は線維化したが黄斑浮腫は残存し，視力は0.02である。結論：網膜細動脈瘤で治療に抵抗する黄斑浮腫があるときには，CNVが関与している可能性がある。

Abstract.　Purpose：To report a case of retinal arterial macroaneurysm with persisent macular edema followed by choroidal neovascularization（CNV）. Case：A 78-year-old female presented with gradually decreasing vision in her right eye since 9 months before. She had had systemic hypertension and diabetes mellitus. Findings：Corrected visual acuity was 0.2 right and 0.9 left. The right fundus showed a white mass along the inferior temporal artery with hard exudates and edema extending to the macula. Optical coherence tomography（OCT）showed macular edema. She was diagnosed with retinal arterial macroaneurysm and was treated by photocoagulation. Repeat photocoagulation 4 months later was followed by submacular hemorrhage with visual acuity decreasing to 0.02. A grayish-white lesion developed and fluorescein angiography showed CNV of 2 disc diameters across 7 months after her initial visit. She was treated by intravitreal injection of anti-VEGF. Another 7 months later,CNV and macroaneurysm became fibrotic with persisent macular edema and visual acuity of 0.02. Conclusion：This case illustrates that CNV may be present when macular edema persists following ruptured retinal macroaneurysm.