内眼炎所見を合併した多発性後極部網膜色素上皮症（MPPE）の1例

A case of multifocal posterior pigment epitheliopathy（MPPE）with intraocular inflammation

要約　目的：内眼炎所見を合併した多発性後極部網膜色素上皮症（MPPE）の症例報告。

症例：39歳男性。両眼の視力低下を自覚して紹介受診。前眼部炎症所見はなく，眼底所見は両眼後極部に漿液性網膜剝離と網膜血管炎，左眼黄斑下に黄白色の滲出性病変と網膜色素上皮剝離を伴っていた。蛍光眼底造影検査では，右眼中心窩に蛍光漏出と蛍光貯留，左眼も蛍光漏出と網膜血管からの蛍光漏出，視神経乳頭の過蛍光の所見を認めた。治療としてステロイド内服やパルス療法，ベバシズマブ硝子体内投与を施行したが反応はなかった。経過や眼所見よりMPPEと診断し，ステロイドの漸減と漏出点に対し網膜光凝固を施行した。

結論：MPPEに網膜血管炎など内眼炎所見を合併したため，診断に時間を要した症例を経験した。早期にステロイド全身投与を開始したが，それにより遷延化し，診断が困難になったと考えられた。

Abstract　Purpose：To report a case of multifocal posterior pigment epitheliopathy（MPPE）with signs of intraocular inflammation.

Case：A 39-year-old male presented with impaired vision in both eyes since 5 days before. He was referred to us with the tentative diagnosis of Vogt-Koyanagi-Harada disease.

Findings：Corrected visual acuity was 0.4 right and 0.6 left. The right eye showed serous retinal detachment in the posterior fundus. The left eye showed exudative lesions and signs of retinal vasculitis all over the fundus. Fluorescein angiography showed dye leakage from the choroid and dye pooling in the subretinal spact in the right eye. The left eye showed dye leakage from retinal vessels. The findings were suggestive of uveitis. Peroral prednisolone at the daily dosis of 30 mg was apparently futile for 2 months. Intravitreal bevacizumab showed no improvement in the left eye. Fundus photocoagulation was applied to exudative lesions after diagnosis of MPPE. Spontaneous improvement set in later. He has been doing well for 3 years until present.

Conclusion：The present case showed findings suggestive of MPPE. The diagnosis was delayed by the presence of retinal vasculitis and by systemic corticosteroid therapy.