臨床眼科67巻2号

2013年02月発行

特集 中心性漿液性脈絡網膜症の病態と治療

関連因子からみた病態

著者： 本田茂¹

所属機関： ¹神戸大学大学院医学研究科外科系講座眼科学分野

ページ範囲：P.156 - P.159

はじめに

　中心性漿液性脈絡網膜症（central serous chorio-retinopathy：CSC）は30～50歳代の男性に好発する疾患である。臨床的には脈絡膜から網膜下への漿液性漏出を主体とする病気で，脈絡膜血管の拡張や透過性亢進などの所見がみられるが，それらの発生メカニズムや原因についてはほとんどわかっていない。疾患の経過中に自然治癒がみられる一方，しばしば再発し，治療が困難なケースも少なくない。また，CSCは加齢黄斑変性，特にポリープ状脈絡膜血管症（polypoidal chroidal vasculopathy：PCV）の危険因子の1つに数えられることもあるが，両疾患の病態的な関連性については現在に至るまで不明である。

　本稿ではCSCの関連因子をまとめ，同疾患の病態メカニズムをできるかぎり生化学的に考察する。また，CSCと加齢黄斑変性における疾患の分子生物学的共通性および相違性を検討する。

参考文献

1）Kitzmann AS, Pulido JS, Diehl NN et al：The incidence of central serous chorioretinopathy in Olmsted County, Minnesota, 1980-2002. Ophthalmology　115：169-173, 2008

2）Ueta T, Obata R, Inoue Y et al：Background comparison of typical age-related macular degeneration and polypoidal choroidal vasculopathy in Japanese patients. Ophthalmology　116：2400-2406, 2009

3）Grieshaber MC, Staub JJ, Flammer J：The potential role of testosterone in central serous chorioretinopathy. Br J Ophthalmol　91：118-119, 2007

4）Ahad MA, Chua CN, Evans NM：Central serous chorioretinopathy associated with testosterone therapy. Eye（Lond）　20：503-505, 2006.

5）Tufan HA, Gencer B, Comez AT：Serum cortisol and testosterone levels in chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol. 2012 Jun 21.［Epub ahead of print］.

6）Zakir SM, Shukla M, Simi ZU et al：Serum cortisol and testosterone levels in idiopathic central serous chorioretinopathy. Indian J Ophthalmol　57：419-422, 2009

7）Haimovici R, Rumelt S, Melby J：Endocrine abnormalities in patients with central serous chorioretinopathy. Ophthalmology　110：698-703, 2003

8）Forooghian F, Meleth AD, Cukras C et al：Finasteride for chronic central serous chorioretinopathy. Retina　31：766-771, 2011

9）Rocha EM, Wickham LA, da Silveira LA et al：Identification of androgen receptor protein and 5 alpha-reductase mRNA in human ocular tissues. Br J Ophthalmol　84：76-84, 2000

10）Gelber GS, Schatz H：Loss of vision due to central serous chorioretinopathy following psychological stress. Am J Psychiatry　144：46-50, 1987

11）Tatham A, Macfarlane A：The use of propranolol to treat central serous chorioretinopathy：an evaluation by serial OCT. J Ocul Pharmacol Ther　22：145-149, 2006

12）Yannuzzi LA：Type A behavior and central serous chorioretinopathy. Trans Am Ophthalmol Soc　84：799-845, 1986

13）Johnson AM, Schermer JA, Vernon PA et al：Genetic correlations among facets of type A behavior and personality. Twin Res Hum Genet　15：491-495, 2012

14）Garg SP, Dada T, Talwar D et al：Endogenous cortisol profile in patients with central serous chorioretinopathy. Br J Ophthalmol　81：962-964, 1997

15）Karadimas P, Bouzas EA：Glucocorticoid use represents a risk factor for central serous chorioretinopathy：a prospective, case-control study. Graefes Arch Clin Exp Ophthalmol　242：800-802, 2004

16）Sunness JS, Haller JA, Fine SL：Central serous chorioretinopathy and pregnancy. Arch Ophthalmol　111：360-364, 1993

17）Weenink AC, Borsje RA, Oosterhuis JA：Familial chronic central serous chorioretinopathy. Ophthalmologica　215：183-187, 2001

18）Park DW, Schatz H, Gaffney MM et al：Central serous chorioretinopathy in two families. Eur J Ophthalmol　8：42-47, 1998

19）Haimovici R, Koh S, Gagnon DR et al；Central Serous Chorioretinopathy Case-Control Study Group：Risk factors for central serous chorioretinopathy：a case-control study. Ophthalmology　111：244-249, 2004

20）Tittl MK, Spaide RF, Wong D et al：Systemic findings associated with central serous chorioretinopathy. Am J Ophthalmol　128：63-68, 1999

21）Fraunfelder FW, Fraunfelder FT：Central serous chorioretinopathy associated with sildenafil. Retina　28：606-609, 2008

22）Aliferis K, Petropoulos IK, Farpour B et al：Should central serous chorioretinopathy be added to the list of ocular side effects of phosphodiesterase 5 inhibitors? Ophthalmologica　227：85-89, 2012

23）Vance SK, Imamura Y, Freund KB：The effects of sildenafil citrate on choroidal thickness as determined by enhanced depth imaging optical coherence tomography. Retina　31：332-335, 2011

24）French DD, Margo CE：Central serous chorioretinopathy and phosphodiesterase-5 inhibitors：a case-control postmarketing surveillance study. Retina　30：271-274, 2010

. Eur J Ophthalmol　16：274-278, 2006

：a risk factor for the developement of the central serous chorioretinopathy. Klin Oczna　111：30-32, 2009

27）Shin MC, Lim JW：Concentration of cytokines in the aqueous humor of patients with central serous chorioretinopathy. Retina　31：1937-1943, 2011

28）Lim JW, Kim MU, Shin MC：Aqueous humor and plasma levels of vascular endothelial growth factor and interleukin-8 in patients with central serous chorioretinopathy. Retina　30：1465-1471, 2010

29）Miura Y, Roider J：Triamcinolone acetonide prevents oxidative stress-induced tight junction disruption of retinal pigment epithelial cells. Graefes Arch Clin Exp Ophthalmol　247：641-649, 2009

30）Valamanesh F, Torriglia A, Savoldelli M et al：Glucocorticoids induce retinal toxicity through mechanisms mainly associated with paraptosis. Mol Vis　13：1746-1757, 2007