臨床眼科78巻11号

2024年10月発行

増刊号 6年前の常識は現在の非常識！—AI時代へ向かう今日の眼科医へ

Ⅷ．網膜

Pachychoroid（パキコロイド）

著者： 松本英孝¹

所属機関： ¹群馬大学医学部附属病院眼科

ページ範囲：P.232 - P.239

文献概要

ここが変わった！

以前の常識

・脈絡膜外層血管の拡張を伴う脈絡膜肥厚をpachychoroidと呼ぶが，病態は解明されていなかった．

・Pachychoroidがアジア人の加齢黄斑変性の発症に関与する可能性が示唆されていた．

現在の常識

・Pachychoroidの病態には渦静脈のうっ滞が関与する．

・日本人の新生血管型加齢黄斑変性の約50％はpachychoroidを合併している．

・Pachychoroid関連疾患の治療として光線力学的療法の有効性が報告されている．

＊本論文中，動画マークのある箇所につきましては，関連する動画を見ることができます（公開期間：2029年10月）．

参考文献

1）Warrow DJ, Hoang QV, Freund KB：Pachychoroid pigment epitheliopathy. Retina 33：1659-1672, 2013

2）Cheung CMG, Lee WK, Koizumi H, et al：Pachychoroid disease. Eye（Lond） 33：14-33, 2019

3）Yanagi Y：Pachychoroid disease：a new perspective on exudative maculopathy. Jpn J Ophthalmol 64：323-337, 2020

4）Fung AT, Yannuzzi LA, Freund KB：Type 1（sub-retinal pigment epithelial）neovascularization in central serous chorioretinopathy masquerading as neovascular age-related macular degeneration. Retina 32：1829-1837, 2012

5）Pang CE, Freund KB：Pachychoroid neovasculopathy. Retina 35：1-9, 2015

6）松本英孝，秋山英雄：CSCを代表とするpachychoroid関連疾患の病態に迫る．日本の眼科95：1134-1140，2024

7）Pang CE, Shah VP, Sarraf D, et al：Ultra-widefield imaging with autofluorescence and indocyanine green angiography in central serous chorioretinopathy. Am J Ophthalmol 158：362-371.e2, 2014

8）Sonoda S, Sakamoto T, Kuroiwa N, et al：Structural changes of inner and outer choroid in central serous chorioretinopathy determined by optical coherence tomography. PLoS One 11：e0157190, 2016

9）Ersoz MG, Karacorlu M, Arf S, et al：Outer nuclear layer thinning in pachychoroid pigment epitheliopathy. Retina 38：957-961, 2018

10）Lee JH, Kim JY, Jung BJ, et al：Focal disruptions in ellipsoid zone and interdigitation zone on spectral-domain optical coherence tomography in pachychoroid pigment epitheliopathy. Retina 39：1562-1570, 2019

11）Ersoz MG, Karacorlu M, Arf S, et al：Pachychoroid pigment epitheliopathy in fellow eyes of patients with unilateral central serous chorioretinopathy. Br J Ophthalmol 102：473-478, 2018

12）Dansingani KK, Balaratnasingam C, Klufas MA, et al：Optical coherence tomography angiography of shallow irregular pigment epithelial detachments in pachychoroid spectrum disease. Am J Ophthalmol 160：1243-1254.e2, 2015

13）Matsumoto H, Hoshino J, Mukai R, et al：Chronic choriocapillaris ischemia in dilated vortex vein region in pachychoroid neovasculopathy. Sci Rep 11：16274, 2021

14）Lee WK, Baek J, Dansingani KK, et al：Choroidal morphology in eyes with polypoidal choroidal vasculopathy and normal or subnormal subfoveal choroidal thickness. Retina 36（Suppl 1）：S73-S82, 2016

15）髙橋寛二，永井由巳，大中誠之，他：脈絡膜新生血管の生体イメージングと病理相関．日眼会誌123：284-311，2019

16）Hosoda Y, Miyake M, Yamashiro K, et al：Deep phenotype unsupervised machine learning revealed the significance of pachychoroid features in etiology and visual prognosis of age-related macular degeneration. Sci Rep 10：18423, 2020

17）Matsumoto H, Hoshino J, Mukai R, et al：Clinical characteristics and pachychoroid incidence in Japanese patients with neovascular age-related macular degeneration. Sci Rep 12：4492, 2022

18）Kishi S, Matsumoto H, Sonoda S, et al：Geographic filling delay of the choriocapillaris in the region of dilated asymmetric vortex veins in central serous chorioretinopathy. PLoS One 13：e0206646, 2018

19）Matsumoto H, Kishi S, Mukai R, et al：Remodeling of macular vortex veins in pachychoroid neovasculopathy. Sci Rep 9：14689, 2019

20）Matsumoto H, Hoshino J, Mukai R, et al：Vortex vein anastomosis at the watershed in pachychoroid spectrum diseases. Ophthalmol Retina 4：938-945, 2020

21）Takahashi K, Kishi S：Remodeling of choroidal venous drainage after vortex vein occlusion following scleral buckling for retinal detachment. Am J Ophthal mol 129：191-198, 2000

22）Matsumoto H, Hoshino J, Mukai R, et al：Pulsation of anastomotic vortex veins in pachychoroid spectrum diseases. Sci Rep 11：14942, 2021

23）Imanaga N, Terao N, Nakamine S, et al：Scleral thickness in central serous chorioretinopathy. Ophthalmol Retina 5：285-291, 2021

24）Imanaga N, Terao N, Wakugawa S, et al：Scleral thickness in simple versus complex central serous chorioretinopathy. Am J Ophthalmol 261：103-111, 2024

25）Matsumoto H, Mukai R, Saito K, et al：Vortex vein congestion in the monkey eye：a possible animal model of pachychoroid. PLoS One 17：e0274137, 2022

26）Maruko I, Iida T, Sugano Y, et al：Subfoveal choroidal thickness after treatment of central serous chorioretinopathy. Ophthalmology 117：1792-1799, 2010

27）Tseng CC, Chen SN：Long-term efficacy of half-dose photodynamic therapy on chronic central serous chorioretinopathy. Br J Ophthalmol 99：1070-1077, 2015

28）Matsumoto H, Hiroe T, Morimoto M, et al：Efficacy of treat-and-extend regimen with aflibercept for pachychoroid neovasculopathy and Type 1 neovascular age-related macular degeneration. Jpn J Ophthalmol 62：144-150, 2018

29）Matsumoto H, Mukai R, Kikuchi Y, et al：One-year outcomes of half-fluence photodynamic therapy combined with intravitreal injection of aflibercept for pachychoroid neovasculopathy without polypoidal lesions. Jpn J Ophthalmol 64：203-209, 2020

30）Koh A, Lai TYY, Takahashi K, et al：Efficacy and safety of ranibizumab with or without verteporfin photodynamic therapy for polypoidal choroidal vasculopathy：a randomized clinical trial. JAMA Ophthalmol 135：1206-1213, 2017

31）Teo KYC, Yanagi Y, Lee SY, et al：Comparison of optical coherence tomography angiographic changes after anti-vascular endothelial growth factor therapy alone or in combination with photodynamic therapy in polypoidal choroidal vasculopathy. Retina 38：1675-1687, 2018