Takei Masato, Obana Akira, Inomata Takenori, Tanaka Takao, Shiang Tina, Bae Yuan, Takemura Tamiko, Murakami Akira
Department of Ophthalmology, Japan Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, Japan.
Department of Ophthalmology, Juntendo University Faculty of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
BMC Ophthalmol. 2018 Mar 6;18(1):72. doi: 10.1186/s12886-018-0738-x.
Membranoproliferative glomerulonephritis (MPGN) is characterized by mesangial cell proliferation and is classified into types I, II and III based on structural changes in the glomerular capillary walls. The drusen-like deposits of MPGN type II have been studied, but the fundus changes in MPGN type III have yet to be clarified. We report a case of MPGN type III with multiple deposits in the retinal pigment epithelium (RPE).
A 40-year-old Japanese woman with MPGN type III developed numerous yellow-white patches in the central macula of both eyes. Optical coherence tomography (OCT) showed deposits between the RPE and Bruch's membrane. Fluorescein angiography showed choroidal neovascularization (CNV) and OCT confirmed it as type 1 (sub RPE) CNV with fibrin tissue and subretinal fluid in the right eye. After 12 months, the CNV and subretinal fluid resolved spontaneously but the RPE deposits remained in both eyes. Her final visual acuity was 20/20 in the right eye and 20/16 in the left eye.
We report a case of MPGN type III with multiple deposits in the RPE and CNV, suggesting that various fundus changes occur in MPGN type III and careful fundus follow-up is necessary to prevent vision loss.
膜增生性肾小球肾炎（MPGN）的特征是系膜细胞增殖，根据肾小球毛细血管壁的结构变化分为I型、II型和III型。II型MPGN的玻璃膜疣样沉积物已得到研究，但III型MPGN的眼底改变尚未阐明。我们报告一例III型MPGN患者，其视网膜色素上皮（RPE）有多处沉积物。
一名患有III型MPGN的40岁日本女性双眼黄斑中心出现大量黄白色斑块。光学相干断层扫描（OCT）显示RPE与布鲁赫膜之间有沉积物。荧光素血管造影显示脉络膜新生血管（CNV），OCT证实右眼为1型（RPE下）CNV，伴有纤维蛋白组织和视网膜下液。12个月后，CNV和视网膜下液自发消退，但双眼RPE沉积物仍存在。她最后的视力右眼为20/20，左眼为20/16。
我们报告一例III型MPGN患者，其RPE和CNV有多处沉积物，提示III型MPGN会出现各种眼底改变，需要仔细进行眼底随访以预防视力丧失。
