強度近視に合併する血管新生型黄斑部出血—予後不良因子の検討

Prognostic factors of choroidal neovascularization in degenerative myopia

　強度近視に合併する血管新生型黄斑出血の予後不良因子を検討した。本症50例55眼を年齢と後極部の強度近視性網脈絡膜萎縮の程度で4群に分類し，各群の屈折，眼軸長，活動期における最大の血管板の大きさ，病巣の大きさ，および1年以上の経過観察例の最終視力を調べた。

　萎縮軽度群では萎縮強度群に比し血管板と病巣が大きい症例が多かった（p＜0.01）。萎縮軽度群でも若年者より老年者のほうが血管板と病巣が大きく，最終視力の低下する例が多かった。

　この結果から，新生血管の成長にはある程度健常な網膜神経上皮が必要と考えられた。高齢者では，それに加えて，加齢による色素上皮およびBruch膜の変化が加わり，重症化すると推測された。

We evaluated the prognostic factors of choroidal neovascularization associated with degenerative myopia in 55 eyes, 50 patients. The cases were divided into 4 group according to age and degree of myopic chorioretinal atrophy (CRA) in the macula. We evaluated the refractive power, axial length, size of neovascular membrane and of hemorrhage, exudate and serous retinal detachment during the active phase. Final visual acuity was also consid-ered in cases followed up for one year or more. The group with slight CRA showed larger fibrovascular membrane and area of hemorrhage, exudate and serous retinal detachment than in groups with intense CRA (p＜0.01). In the group with slight CRA, elder cases showed larger fibrovascular mem-brane and greater visual loss than in younger cases. These findings seemed to suggest that growth of neovascular membrane is accelerated by the pre-sence of more or less healthy retinal neuroepithe-lium and by age-related changes in the pigment epithelium and Bruch's membrane.