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要約 目的:黄斑部に限局したサイトメガロウイルス(CMV)網膜炎の3例を経験したので報告する。
症例1:23歳,男性。4歳で腸管ベーチェット病を発症,これまでぶどう膜炎の発症はなかった。ベーチェット病のフォローのための定期診時,左視力は(0.7)であった。左眼の中心窩上鼻側に黄白色病変が出現し,6か月後には病変が中心窩まで拡大した。病変部位の動脈炎と,光干渉断層計(OCT)にて網膜全層構造の消失を伴った高輝度病変が確認され,前房水PCRを施行しCMV陽性が確認された。ガンシクロビル点滴治療開始となったが,病変は再発を繰り返しながら中心窩耳側まで進展し,発症9か月後にはOCTで全層が欠損し,内境界膜のみ残存する所見となった。
症例2:54歳,男性。5年前より全身性エリテマトーデスにてプレドニゾロン,タクロリムス,ミコフェノール酸モフェチルの内服治療中。2か月前より左視力低下,黄斑に黄白色病変,線状出血が出現し信州大学医学部附属病院眼科(当科)に紹介された。初診時の視力は左(0.06)で,黄白色病変は前医に受診した際より減少していたが,病変部に白鞘化した動脈と出血斑を認めた。前医のOCTにて網膜全層が欠損しており,CMV網膜炎を疑って前房水PCRを施行し陽性が確認された。
症例3:62歳,男性。悪性リンパ腫の加療中。1週間前からの右視力低下,黄白色病変,出血斑を認め当科に紹介された。初診時の視力は右(0.3),フルオレセイン蛍光眼底造影検査にて病変部位に動脈炎所見があり,OCTにて層構造の消失を伴った高輝度病変の中に網膜欠損の所見を認めた。CMV網膜炎を疑って前房水PCRを施行し陽性が確認された。
結論:黄斑部に限局したCMV網膜炎を経験した。いずれも初期にOCTにて網膜全層構造の消失を伴った高輝度病変が確認され,その後次第に網膜構造が欠損していく所見となった。
Abstract Purpose:This report presents three cases of cytomegalovirus(CMV)retinitis confined to the macula.
Case:Case 1 was a 23-year-old man diagnosed with intestinal Behçet's disease at 4 years of age had no history of uveitis. Routine ophthalmologic examination revealed that visual acuity was 0.7 in the left eye. A yellowish-white lesion was observed in the superior nasal aspect of the fovea of the left eye;this lesion extended to the fovea 6 months later. Arteritis was observed at the same site. Optical coherence tomography(OCT)revealed a hyperintense lesion with loss of all retinal structures. Anterior chamber aqueous humor PCR was positive for CMV. Ganciclovir infusion was commenced;however, the lesion recurred repeatedly and extended to the auricular side of the fovea. OCT revealed loss of all layers nine months after the onset, with only the inner limiting membrane being retained.
Case 2 was a 54-year-old man receiving prednisolone for systemic lupus erythematosus for 5 years who was referred to our department with visual acuity loss in the left eye. Yellow-white macular lesions and linear hemorrhage were observed. Visual acuity was 0.06. The yellow-white lesions had decreased in size since the previous visit;however, sheathing arteries and hemorrhagic spots were observed. OCT performed previously revealed loss of all retinal layers, which was suggestive of CMV retinitis. Anterior chamber aqueous humor PCR was positive for CMV.
Case 3 was a 62-year-old man referred to our department with vision loss, yellow-white lesions, and hemorrhagic spots observed one week earlier. Visual acuity was 0.3 in the right eye. Fluorescein angiography revealed arteritis in the lesion. OCT revealed retinal defects in a hyperintense lesion with loss of the laminar structure, which was suggestive of CMV. Anterior chamber aqueous humor PCR was positive for CMV.
Conclusion:CMV retinitis confined to the macula were observed in all three cases. OCT revealed hyperintense lesions with loss of all layers of retinal structure in the early stages, followed by gradual loss of retinal structure.

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