Vogt-小柳-原田病新鮮例に対するステロイド大量療法とパルス療法の比較

Comparison between high-dose and pulse therapy with systemic corticosteroid for Vogt-Koyanagi-Harada disease

　Vogt-小柳-原田病の新鮮例に対するステロイドの大量療法とパルス療法の効果を比較した。対象は発症から1か月以内で未治療の自験例30例である。男性11例，女性19例で，年齢は21～67歳，平均38歳であった。大量療法とパルス療法の選択は無作為に行った。大量療法ではプレドニゾロン200mg/日を初回量とし，パルス療法ではメチルプレドニゾロン1,000mg/日を3日間続け，以後漸減した。大量療法群16例とパルス療法群14例との間に，治療開始前の所見には差がなかった。全症例で1.0以上の最終視力が得られた。大量療法群では夕焼け状眼底の頻度が有意に高かった。再発，遷延，副作用については両群間に差がなかった。本症の新鮮例に対し，ステロイド薬の大量療法とパルス療法は同等に有効であると結論される。

　We compared the effect of high-dose and pulsed corticosteroid therapy for fresh cases of Vogt-Koyanagi-Harada disease. Thirty cases entered this prospective study. All were seen by us within one month after onset and had received no treatment. The series comprised 11males and 19 females. Their ages ranged from 21 to 67 years,average 38 years. They were randomly assigned to high-dose or pulsed therapy. There was no difference in clinical features between the two groups before start of treatment. Patients in the former group received peroral prednisolone 200mg per day. Those in the later received peroral methylprednisolone at the daily dosis of 1000mg to be continued for 3 consecutive days. All the 30 cases regained the final visual acuity of 1.0. There was a significantly higher incidence of‘sunset-glow fundus’in cases in the high-dose group. There were no differences between the two groups regarding recurrence,protracted course or side effects of therapy. The findings show that both therapeutic modalities are equally effective for fresh cases of Vogt-Koyanagi-Harada disease.