傍乳頭網膜血管腫の1例

A case of juxtapapillary retinal hemangioma

　左眼乳頭耳側縁に網膜血管腫を生じた57歳女性の1例を経験した。中心暗点を主訴に受診し，3年間に血管腫は2／3乳頭径から1.5乳頭径に増大し，乳頭耳側縁に半月状となった。眼底後極部に滲出性網膜剥離と硬性白斑沈着が増加し，矯正視力は0.8から0.3に低下した。血管腫に対し光凝固を行ったが，凝固中に著しい黄白色の網膜下滲出液を生じ，眼底後極部の網膜剥離，硬性白斑沈着が増加した。約1か月間隔で光凝固をさらに4回繰り返したところ，初診から15か月後に血管腫は乳頭耳側縁に三日月状に残存するのみとなり，滲出性網膜剥離，硬性白斑は消失した。しかし乳頭黄斑線維束は萎縮し視力は0.02になった。

A 57-year-old female presented with central scotoma and decreased vision in the left eye. Funduscopy showed an orange colored tumor along the superotemporal margin of the optic disc. The tumor was two-thirds of disc diameter. Exudative retinal detachment with hard exudates was present around the disc and the macular area. The tumor gradually enlarged to attain 1.5 disc diameter in three years. Exudative detachment enlarged and cystic retinal edema appeared in the papillomacular bundle. The vision decreased to 0.3. Fluorescein angiography showed the tumor to be fed by a cilioretinal artery. The tumor was diagnosed as solitary juxtapapillary capillary retinal hemangioma. Photocoagulation was applied directly to the tumor in 6 repeated sessions. Each session was followed by marked exudative subretial fluid and by precipitation of hard exudates in the macula. The tumor finally reduced in size and the exudative retinal detachment subsided. The papillomacular nerve fiber bundle became atrophic. The final vision was 0.02.