急性骨髄性白血病患児にみられた急性網膜壊死の1例

Acute retinal necrosis in a child with acute myeloid leukemia

目的：急性網膜壊死が発症した急性白血病患児の報告。症例：11歳女児の右眼視力が低下し，その翌日に受診した。5か月前から急性骨髄性白血病に対し免疫抑制薬で加療中であった。矯正視力は右0.03，左1.5で，右眼の眼底全周に黄白色滲出病巣と胞状網膜剝離があった。前房水から単純ヘルペスウイルスが検出され，急性網膜壊死と診断した。アシクロビルの全身投与を開始し，第11病日に輪状締結術とシリコーンオイル注入術を併用する硝子体手術を行った。結果：網膜は復位し，0.1の矯正視力が得られた。手術の7か月後にシリコーンオイルを抜去し，以後6か月後の現在まで経過は良好である。結論：急性骨髄性白血病の小児に発症した網膜剝離を伴う急性網膜壊死に対し，アシクロビルの全身投与と硝子体手術が奏効した。

Purpose：To report acute retinal necrosis in a child with acute myeloid leukemia. Case：A 11-year-old girl presented with blurring of vision in her right eye since the day before. She had been receiving immunosuppressive agent for acute meyloid leukemia since 5months before. Corrected visual acuity was 0.03 right and 1.5 left. Her right fundus showed exudative lesion in all the circumference with bullous retinal detachment. Herpes simplex virus was detected in the aqueous humor. She was diagnosed with acute retinal necrosis and was given acyclovir. On day 11 of disease,the right eye received vitrectomy,scleral encircling,and silicone-oil tamponade. Results：The retina became reattached after vitrectomy. Corrected visual acuity of 0.1 was obtained after removal of silicone oil 7months later. She is doing well for 6months until present. Conclusion：Treatment with systemic acyclovir and vitreous surgery was effective for acute retinal necrosis in a girl with acute myeloid leukemia.