急激な近視化を主訴とした原田病の1例

Acute myopia as the initial manifestation in a case of Harada disease

34歳男性が前日からの急激な近視化を主訴として受診した。裸眼視力は従来は左右とも1.5であったという。初診時には右眼に－3.5D，左眼に－3.0Dの近視があった。軽度の毛様充血と浅前房があったが，明らかな虹彩炎の所見はなかった。蛍光眼底造影で斑状の色素漏出，髄液に細胞増多があり，原田病と診断した。メチルプレドニゾロンによるパルス療法とプレドニゾロンの内服で多発性滲出性網膜剝離は軽快し，右眼＋1.0D，左眼＋0.5Dの遠視になった。この症例は，原田病が急性近視で初発する可能性があることを示している。

A 34-year-old man presented with acute myopia since the previous day. Uncorrected visual acuity was reportedly 1.5 in either eye before. When seen by us,his visual acuity was 1.5 when corrected by －3.5 diopters right and 1.0 corrected by －3.0 diopters left. Both eyes showed slight ciliary injection and shallow anterior chamber. Signs of iridocyclitis were absent. Fluorescein angiography showed multiple dots of dye leakage. Cerebrospinal fluid showed increased cells. These findings led to the diagnosis of Vogt-Koyanagi-Harada（VKH）disease. Retinal detachment and myopia improved after treatment with pulsed methylprednisolone followed by peroral prednisolone. State of refraction became＋1.0 diopters right and＋0.5 diopters left. This case illustrates that acute myopia may be the initial manifestation of VKH disease.