原田病高齢者の臨床像とICG蛍光眼底造影の特徴

Clinical and indocyanine green angiographic features in aged patients of Vogt-Koyanagi-Harada disease

要約　過去5年間に原田病患者30例が当科を受診した。男性11人，女性19人で，すべて両眼発症であった。年齢は10～73歳，平均47.1歳であった。30歳以上が29人（97％），60歳以上が5人（16.7％）で従来の報告よりも高齢者が多かった。病型を，前眼部型，眼底型，両者を含む混合型に分けるとき，30歳代では眼底型が57.1％であるのに対し，60歳以上はすべて混合型であった。乳頭浮腫は，40歳未満で12.5％，40歳以上で59.9％にあった。乳頭浮腫がある症例では，インドシアニングリーン蛍光造影で，脈絡膜造影開始が有意に遅延していた。加齢とともに脈絡膜を含む眼内循環動態が変化し，原田病での臨床像に関係している可能性がある。

Abstract.　We reviewed 30 consecutive cases of Vogt-Koyanagi-Harada（VKH）disease seen during the past 5 years. The series comprised 11 males and 19 females. All were bilaterally affected. The ages ranged from 10 to 73 years,average 47.1 years. There were 29 patients（97％）aged 30 years or over and 5 patients（16.7％）aged 60 years or over. The present series showed a higher incidence of aged patients than in the previous reports. The clinical pattern was tentatively classified into anterior type,fundus type,and mixed type. Fundus type was present in 57.1％ of patients in the fourth decade of age. All patients aged 60 or over were of mixed type. Disc edema was present in 12.5％ of patients under 40 years of age and in 60 and of those over 40 years. Arm-to-choroid circulation time was significantly prolonged in eyes with disc edema. The findings suggest that the intraocular hemodynamics,including the choroid,is affected by ageing process and modifies the clinical features of VKH disease.