両眼性脈絡膜皺襞に伴う後天性遠視化の1例

Bilateral acquired hyperopia with choroidal folds

要約　目的：両眼性に脈絡膜皺襞を認め，遠視化を伴った1例を報告する。

症例：61歳，男性。元来，近視用の眼鏡を装用していたが，最近，急に遠視寄りになり，眼鏡が不要になったため，原因精査希望で近医を受診した。

所見：両眼の遠視化と眼底後極部に水平方向に走る脈絡膜皺襞を認めた。低眼圧を認めず，他院にてCT・MRIを施行したが眼窩に腫瘤性および炎症性病変を認めなかった。頭蓋内，副鼻腔にも脳血管障害その他の占拠性病変を認めず，原因不明にて当院にさらなる精査目的で紹介された。当院初診時の視力は右0.9（1.2），左1.0（1.5），等価球面度数で右＋0.25D，左−0.50D，眼軸長右22.8mm，左23.2mmであった。Bモードで眼球後壁の平坦化と視神経周囲のくも膜下腔の拡大を認めた。フルオレセイン蛍光眼底造影では皺襞に一致した淡い過蛍光のほか，インドシアニングリーン蛍光眼底造影にて視神経乳頭周囲に放射状に伸びる低蛍光の線条を認め，それに沿って眼底自発蛍光の斑状過蛍光を認めた。眼症状は固定し，頭痛その他の全身症状もなく，CT・MRIで頭蓋内病変を認めないため，髄液検査は希望されず脳脊髄圧亢進の有無は不明である。

結論：原因疾患を認めない両眼性の脈絡膜皺襞に伴う遠視化の1症例を経験した。両眼性の特発性脈絡膜皺襞による後天性遠視化の報告は海外に数十例あり，良性とされているが，発症メカニズムが不明で経過もまちまちなため，注意して経過観察する必要がある。

Abstract　Purpose：To report a case of bilateral acquired hyperopia accompanying choroidal folds.

Case：A 61-year-old man consulted a private clinic because of sudden onset, spontaneous resolution of myopia in his both eyes.

Findings and Clinical Course：In the both eyes, choroidal folds running horizontally at the posterior pole were observed. CT and MRI, which were performed in another hospital, showed neither inflammatory nor space-occupying lesion in the orbital, paranasal, and intracranial cavities. Then he was presented to our hospital for further examination. Visual acuity was 0.9（1.2）in his right eye and 1.0（1.5）in his left eye. The equivalent spherical error was＋0.25D and−0.5D and the axial length was 22.8 mm and 23.2 mm, respectively. B-mode showed flattening of the posterior part of an eye ball in both eyes. Mild hyperfluorescence was observed, reflecting choroidal folds. Angioid streaks-like hypofluorescence, along which patchy pattern abnormal fundus hyper-autofluorescence, was seen. Intracranial pressure was not measured due to the patient's request.

Conclusion：Previous reports showed some cases of acquired hyperopia with idiopathic choroidal folds, which were considered benign. Nevertheless, careful observation should be continued due to unknown mechanism underlying.