外傷性低眼圧黄斑症による長期視力低下例の光干渉断層計（OCT）所見

Optical coherence tomographic features in a case of traumatic hypotonic maculopathy with persistent visual impairment

　23歳女性が右眼の低眼圧で紹介された。3年前に転倒して右眼を打撲し，以後視力低下を自覚している。受診時の右眼矯正視力は0.1，眼圧は3mmHgであった。鼻側上方の1／5周に隅角解離があった。黄斑を含む網膜に皺襞があり，螢光眼底造影でその部位の一部に色素上皮の異常による過螢光があった。毛様体強膜縫着術で隅角解離は改善し，眼圧は10mmHg前後に回復した。黄斑部の固定皺襞は術後3か月以上残存し，視力は0.5であった。光干渉断層計（OCT）と螢光眼底造影の所見から，長期視機能障害は網膜上膜による皺襞形成，網膜下組織の器質化，網膜色素上皮の増殖に加え，外傷時の視神経乳頭の循環障害よると推定された。

A 23-year-old female was referred to us for hypotony in her right eye. She had suffered blunt trauma to her right eye when falling 3 years before. Her corrected visual acuity was 0.1 right. The right intraocular pressure was 3 mmHg. Gonioscopy showed cyclodialysis in the superior temporal sector involving one-fifth of the circumference. Funduscopy showed retinal folds involving the macula. Fluorescein angiography showed hyperfluorescent lesion within the area of retinal folds which was interpreted as due to impaired retinal pigment epithelium. Direct suturing of the ciliary body to the sclera induced recovery of intraocular pressure to 10 mmHg. Macular folds persisted longer than 3 months after surgery with the visual acuity remained at 0.5. Findings by optical coherence tomography and fluorescein angiography seemed to suggest that persistent visual impairment was due to retinal folds secondary to epiretinal membrane, organization of subretinal tissue, proliferation of retinal pigment epithelium in addition to impaired circulation in and around the optic disc at the time of trauma.