Snowbankを伴う中間型ぶどう膜炎の赤外蛍光眼底造影像と治療経過

Therapeutic outcome and indocyanine green angiographic features in a case of intermediated uveitis

　66歳の男性が，1か月前からの左眼霧視で受診した。左眼矯正視力は0.5で、軽度の硝子体混濁と耳側網膜周辺部にsnowbankがあった。フルオレセイン蛍光造影（FA）でsnowbankからの色素漏出，赤外蛍光造影（IA）で脈絡膜循環不全による低蛍光と血管透過性亢進があった。中間型ぶどう膜炎と診断した。3か月間のステロイド薬の結膜下注射と内服でsnowbankは消失し，視力は1.0に回復した。FAでは正常，IAでは脈絡膜循環不全の所見が得られた。ステロイド薬離脱後に再発した。中間型ぶどう膜炎での病態把握と治療の評価には，頻回のIAが有用である。

A 66-year-old male presented with blurring of vision in his left eye since one month before. Corrected visual acuity was 0.5 in the affected eye. The left eye showed mild vitreous opacity and snowbank in the temporal peripheral fundus. Fluorescein angiography (FA) showed dye leakage from the snowbank. Indocyanine green angiography (IA) showed generalized hypofluorecence and hyperpermeable choroidal vessels. He was diagnosed with intermediate uveitis. Topical and systemic corticosteroid induced disappearance of snowbank 3 months later with recovery of vision to 1.0. FA showed normal findings and IA showed persistent choroidal circulatory insufficiency. Withdrawal of corticosteroid was followed by flare-up of uveitis. This case illustrates the usefulness of repeated IA in detecting the underlying pathophysi-ological process and in evaluating the therapeutic outcome in intermediate uveitis.