臨床眼科67巻10号

2013年10月発行

連載 今月の話題

強度近視眼の画像診断の進歩

著者： 大野京子¹ 森山無価¹

所属機関： ¹東京医科歯科大学眼科学教室

ページ範囲：P.1611 - P.1620

　強度近視という病態は，眼科画像診断解析に非常に適した病態ではないだろうか。以前からインドシアニングリーン赤外蛍光眼底造影（IA）などにより，強度近視眼では，網膜脈絡膜の高度な菲薄化に伴い，正視眼では観察できない強膜内および球後血管が観察されることが知られていた。最近の光干渉断層計（OCT）の進歩に伴い，強度近視眼では眼球深部構造を明瞭に可視化することが可能となり，強度近視眼の病態解明が進んだだけでなく，正視眼では観察できないレベルの深部構造の可視化という大きな意味をもつ。さらに微細構造の可視化にとどまらず，3D MRIを用いた眼球形状の解析は，生体において，眼球そのものの形を3次元的に捉えるという新たな画像診断の領域を切り開いた。今後，病的近視において，後天的な眼球変形がいかに網膜・視神経を障害するかが明らかとなり，それに基づき視覚障害が生じる前に未然に是正する治療の確立へと結びつくと期待される。

参考文献

1）Takano M, Kishi S：Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma. Am J Ophthalmol　128：472-476, 1999

2）Margolis R, Spaide RF：A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes. Am J Ophthalmol　147：811-815, 2009

3）Moriyama M, Ohno-Matsui K, Hayashi K et al：Topographical analyses of shape of eyes with pathologic myopia by high-resolution three dimensional magnetic resonance imaging. Ophthalmology　118：1626-1637, 2011

4）Moriyama M, Ohno-Matsui K, Modegi T et al：Quantitative Analyses of High-Resolution 3D MR Images of Highly Myopic Eyes to Determine Their Shapes. Invest Ophthalmol Vis Sci　53：4510-4518, 2012

5）Wu PC, Chen YJ, Chen CH et al：Assessment of macular retinal thickness and volume in normal eyes and highly myopic eyes with third-generation optical coherence tomography. Eye　22：551-555, 2008

6）Luo HD, Gazzard G, Fong A et al：Myopia, axial length, and OCT characteristics of the macula in Singaporean children. Invest Ophthalmol Vis Sci　47：2773-2781, 2006

7）Ikuno Y, Tano Y：Retinal and choroidal biometry in highly myopic eyes with spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci　50：3876-3880, 2009

8）Fujiwara T, Imamura Y, Margolis R et al：Enhanced depth imaging optical coherence tomography of the choroid in highly myopic eyes. Am J Ophthalmol　148：445-450, 2009

9）Flores-Moreno I, Lugo F, Duker JS et al：The relationship between axial length and choroidal thickness in eyes with high myopia. Am J Ophthalmol　155：314-319, 2013

10）Li XQ, Larsen M, Munch IC：Subfoveal choroidal thickness in relation to sex and axial length in 93 Danish university students. Invest Ophthalmol Vis Sci　52：8438-8441, 2011

11）Takahashi A, Ito Y, Iguchi Y et al：Axial length increases and related changes in highly myopic normal eyes with myopic complications in fellow eyes. Retina　32：127-133, 2012

12）Nishida Y, Fujiwara T, Imamura Y et al：Choroidal thickness and visual acuity in highly myopic eyes. Retina　32：1229-1236, 2012

13）Maruko I, Iida T, Sugano Y et al：Morphologic analysis in pathologic myopia using high-penetration optical coherence tomography. Invest Ophthalmol Vis Sci　53：3834-3838, 2012

14）Ohno-Matsui K, Akiba M, Modegi T et al：Association between shape of sclera and myopic retinochoroidal lesions in patients with pathologic myopia. Invest Ophthalmol Vis Sci　53：6046-6061, 2012

15）Curtin BJ：The Myopias：basic science and clinical management. Harpercollins College Div, New York, p.177, 1985

16）Ohno-Matsui K, Akiba M, Ishibashi T et al：Observations of vascular structures within and posterior to sclera in eyes with pathologic myopia by swept-source optical coherence tomography. Invest Ophthalmol Vis Sci　53：7290-7298, 2012

17）Ohno-Matsui K, Morishima N, Ito M et al：Posterior routes of choroidal blood outflow in high myopia. Retina　16：419-425, 1996

18）Park SC, De Moraes CG, Teng CC et al：Enhanced depth imaging optical coherence tomography of deep optic nerve complex structures in glaucoma. Ophthalmology　119：3-9, 2012

19）Ohno-Matsui K, Akiba M, Moriyama M et al：Imaging the retrobulbar subarachnoid space around the optic nerve by swept source optical coherence tomography in eyes with pathologic myopia. Invest Ophthalmol Vis Sci　52：9644-9650, 2011

20）Ohno-Matsui K, Futagami S, Yamashita S et al：Zinn-Haller arterial ring observed by ICG angiography in high myopia. Br J Ophthalmol　82：1357-1362, 1998

21）Ohno-Matsui K, Akiba M, Moriyama M et al：Acquired optic nerve and peripapillary pits in pathologic myopia. Ophthalmology　119：1685-1692, 2012

22）Curtin BJ：The posterior staphyloma of pathologic myopia. Trans Am Ophthalmol Soc　75：67-86, 1977

23）Freund KB, Ciardella AP, Yannuzzi LA et al：Peripapillary detachment in pathologic myopia. Arch Ophthalmol　121：197-204, 2003

24）舘野博子・高橋寛二・福地俊雄・他：近視眼の視神経乳頭周囲にみられる脈絡膜分離のOCT3所見．臨床眼科　59：327-331，2005

25）Toranzo J, Cohen SY, Erginay A：Peripapillary intrachoroidal cavitation in myopia. Am J Ophthalmol　140：731-732, 2005

26）Spaide RF, Akiba M, Ohno-Matsui K：Evaluation of peripapillary intrachoroidal cavitation with swept source and enhanced depth imaging optical coherence tomography. Retina　32：1037-1044, 2012

27）Yeh SI, Chang WC, Wu CH et al：Characteristics of peripapillary choroidal cavitation detected by optical coherence tomography. Ophthalmology　120：544-552, 2013

28）Ohno-Matsui K, Akiba M, Moriyama M et al：Intrachoroidal cavitation in macular area of eyes with pathologic myopia. Am J Ophthalmol　154：382-393, 2012

29）Baba T, Ohno-Matsui K, Futagami S et al：Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia. Am J Ophthalmol　135：338-342, 2003

30）Ohno-Matsui K, Akiba M, Moriyama M：Macular pits and scleral dehiscence in highly myopic eyes with macular chorioretinal atrophy. Retinal Cases & Brief Reports（in press）