硝子体手術によりぶどう膜炎が軽快した再発性多発性軟骨炎の1例

Vitreous surgery was effective for uveitis in a case of relapsing polychondritis

要約　目的：再発性多発性軟骨炎が続発したぶどう膜炎に対し，硝子体手術が奏効した症例の報告。症例：84歳男性が2日前からの右眼の視力低下と眼痛で受診した。矯正視力は右光覚弁，左0.6であり，右眼に虹彩炎，硝子体混濁，網膜出血，胞状網膜剝離があった。左眼に異常は認められなかった。内因性細菌性眼内炎を疑い，右眼に対し水晶体乳化吸引，眼内レンズ挿入，硝子体切除を行った。10日後に発熱，3週後に両側の耳介の炎症，有痛性関節炎，内耳障害，咳嗽が生じ，再発性多発性軟骨炎と診断した。手術の2か月後に眼内炎は軽快し，視力は0.2に回復した。結論：本症例に硝子体手術が奏効したのは，再発性多発性軟骨炎がⅡ型コラーゲンに対する自己免疫疾患であり，硝子体がⅡ型コラーゲンを主体とする組織であるためと解釈される。

Abstract.　Purpose：To report favorable outcome of uveitis after vitrectomy in a case of relapsing polychondritis Case and Findings：A 84-year-old male presented with pain and blurring of vision in his right eye since 2 days before. His corrected visual acuity was light perception right and 0.6 left. The right eye showed signs of iritis,vitreous opacity,retinal hemorrhages,and bullous retinal detachment. The left eye was free of pathological findings. The right eye received phacoemulsification-aspiration,intraocular lens implantation,and pars plana vitrectomy. Endogenous bacterial endophthalmitis was ruled out by intraoperative findings. High fever developed on day 10 of surgery. Bilateral swelling of conchae,coughing and painful polyarthritis lead to the dianogsis of relapsing polychondritis on day 21 of surgery. Endophthalmitis subsided 2 months after surgery with visual acuity improving to 0.2. Conclusion：Vitrectomy was effective in this patient because relapsing chondritis is an autoimmune disease against type-2 collagen which is also the main component of the vitreous.