血管内大細胞型B細胞リンパ腫に対する全脳照射後に硝子体手術を施行した放射線網膜症の1例

Vitrectomy in a case of radiation retinopathy induced by whole-brain radiation for intravascular large B-cell lymphoma

要約　血管内大細胞型B細胞リンパ腫に対する放射線治療後に放射線網膜症が発症し，硝子体手術を行った症例の報告。症例：48歳男性が両眼の視力低下で受診した。6か月前に脳梗塞として発症した血管内大細胞型B細胞リンパ腫に対して化学療法と放射線治療を受けていた。経過：右眼に－8D，左眼に－6.5Dの近視があり，矯正視力は左右眼とも0.8で，両眼に網膜の軟性白斑が多発し，蛍光眼底造影で網膜に虚血があった。軟性白斑と網膜出血が増悪し，6か月後に視力が右0.3，左0.1に低下した。網膜に光凝固を行ったが，左眼に硝子体出血が生じ，初診から11か月後に硝子体手術を行った。血管内リンパ腫の再燃はなく，最終視力は右0.04，左指数弁である。結論：原疾患が脳内の塞栓性病変であったことと，放射線照射に化学療法を併用したことが，網膜症の経過に影響したと考えられる。

Abstract.　Purpose：To report a case of radiation retinopathy following whole-brain radiation for intravascular large B-cell lymphoma. Case：A 48-year-old male presented with impaired vision in both eyes. He had had cerebral infarction 6 month before and had received chemotherapy and whole-brain radiation. Findings：Both eyes had myopia of about-7 diopters. Corrected visual acuity was 0.8 in either eye. Both eyes showed soft exudates in the retina. Fluorescein angiography showed retinal ischemia. Retinal lesions exacerbated during the next 6 months. Visual acuity decreased to 0.3 right and 0.1 left. Both eyes were treated by photocoagulation. Vitreous hemorrhage developed in the left eye 11 months after his initial visit and was treated by vitrectomy. There has been no recurrence of lymphoma until present. Visual acuity was 0.04 right and counting fingers left at the last visit. Conclusion：Radiation retinopathy in the present case appears to have exacerbated by vaso-occlusive nature of the original disease and by additional systemic chemotherapy.