脈絡膜新生血管抜去術後，色素上皮下の残存新生血管が退縮した1例

A case of spontaneous regression of residual choroidal neovascularization after surgical removal

　51歳男性が5か月前に発見された左眼視力低下と変視症で受診した。左眼矯正視力は0.3であった。傍中心窩に1／2乳頭径大の灰白色の混濁があり，周囲に出血性・漿液性色素上皮剥離があった。蛍光眼底造影で，脈絡膜新生血管（CNV）の縁は中心窩から200μm以内にあった。光干渉断層計で色素上皮下のCNVは確認できず，CNVの一部が神経網膜下にあった。この所見から，CNVはGass分類の1＋2型と判定した。手術で神経網膜下のCNVは抜去できたが，色素上皮下のCNVは途中でちぎれ，一部が色素上皮下に残った。色素上皮欠損は生じなかった。摘出組織に血性滲出物と未熟な血首内皮があったが，線維組織はほとんどなく，全体に脆かった。以後残存CNVは自然退縮し，9か月後の矯正視力は0.8に改善し，術後1年間の観察で再発はない。本症例では色素上皮とCNVの接着様式が通常とは異なっていると推定した。

A 51-year-old man presented with decreased vision since 5 months before. His corrected visual acuity was 0.3 left. The left eye showed a gray turbid patch of 1/2 disc diameter in size close to the fovea. It was surrounded by serous and hemorrhagic detachment of retinal pigment epithelium (RPE). Angiographic studies showed the margin of choroidal neovascularization (CNV) to be within 200 μm from the fovea. Optical coherence tomography showed the CNV to be present posterior and anterior to the RPE. The CNV was thus classified as type 1 and 2 after Gass. During surgery, the subretinal component of CNV was removed but the sub-RPE component was torn and remained there. There was no RPE defect. Histologically, the removed CNV tissue contained immature vascular endothelium and little fibrous tissue, showing the CNV mass to be fragile. The remnant CNV underwent spontaneous regression, resulting in visual acuity of 0.8 9 months later with no recurrence up to one year after surgery. It appeared that an unusual attach-ment was present between RPE and CNV in this case.