寄生虫関連が疑われたぶどう膜炎の臨床像

Clinical features of uveitis of presumed parasitic origin

目的：寄生虫の関連が疑われるぶどう膜炎の臨床像の検討。対象：過去42か月間に寄生虫関連の免疫血清抗体が陽性であったぶどう膜炎12例12眼。結果：全例が片眼性で，年齢は19～74歳（平均37歳）であった。初診時の患眼視力は0.1～1.5（平均0.68）。複数抗原に対する陽性反応が6例にあった。硝子体混濁6例，眼底周辺部の肉芽腫と血管炎が各5例，滲出斑と好酸球増加が各4例，黄斑上膜が3例，牽引性網膜剝離と黄斑浮腫と黄斑変性が各2例にあった。副腎皮質ステロイド薬投与で80％に症状改善が得られた。硝子体手術は4例に行われ，3例で視力が2段階以上改善した。結論：寄生虫関連ぶどう膜炎は片眼性であり，周辺部肉芽腫や黄斑病変などの後眼部病変と好酸球増加を示し，副腎皮質ステロイド薬治療と硝子体手術に良好に反応するという特徴がある。

Purpose：To describe the clinical features of uveitis presumably due to parasitic infection. Cases：This retrospective study comprised 12 cases of uveitis during the past 42 months. All the cases were positive for immunoserologic tests to parasite antigens. Results：All the cases were unilaterally affected. Their ages ranged from 19 to 74 years,average 37 years. The visual acuity ranged from 0.1 to 1.5,average 0.68. Six cases（50％）were positive against plural parasite antigens. There were vitreous opacity in 6 cases,retinal vasculitis or peripheral granulomatous lesions in 5,retinal exudates or eosinophilia in 4 cases,epiretinal membrane in 3,and traction retinal detachment,macular edema or macular degeneration in 2. Corticosteroid was effective in 80％ of cases. Vitrectomy induced improved visual acuity in 3 out of 4 operated cases. Conclusion：Unilaterality is the rule in parasite-associated uveitis. The cases frequently show eosinophilia and fundus lesions including peripheral granuloma and macular lesions. The cases respond well to corticosteroid and vitrectomy.