ステロイド大量療法とワーファリン(R)による厳密な抗凝固療法を行った網膜血管閉塞を伴う全身性エリテマトーデス網膜症の2例

Vasoocclusive retinopathy in two cases of systemic lupus erythematosus treated by massive corticosteroid and Warfarin(R)

要約　目的：全身性エリテマトーデス（SLE）網膜症に対してステロイド大量投与と抗凝固療法を行った2症例の報告。症例：29歳女性が1週前からの左眼霧視で受診した。1か月前にSLEと診断されていた。矯正視力は右1.5，左0.4で，両眼とも眼底に軟性白斑が多発し，上方に静脈周囲炎があった。ステロイドの大量療法とワーファリン^(R)投与で眼底所見は鎮静化し，3年後の現在，右1.5，左1.2の視力を得ている。他の1例は40歳男性で，6か月前にSLEと診断され，その頃から両眼の霧視があった。矯正視力は右0.1，左0.6で，両眼に網膜血管の白線化があった。プレドニゾロンとワーファリン^(R)の経口投与3年後の現在まで眼底所見は安定している。結論：活動性のSLE網膜症にはステロイドの全身投与とプロトロンビン時間を視標とした抗凝固療法が奏効することがある。

Abstract.　Purpose：To report two cases of systemic lupus erythematosus treated by massive corticosteroid and warfarin^(R) for occlusive retinopathy. Cases：A 29-year-old female presented with blurred vision in the left eye since one week before. She had been diagnosed with SLE one month before. Her corrected visual acuity was 1.5 right and 0.4 left. Both eyes showed numerous soft exudates with periphlebitis in the superior quadrant. She was treated with massive corticosteroid and warfarin^(R). She obtained visual acuity of 1.5 right and 1.2 left 3 years later. Another 40-year-old male was referred for blurred vision in both eyes. He had been diagnosed with SLE 6 months before. His corrected visual acuity was 0.1 right and 0.6 left. Both eyes showed occlused retinal vessels. He was given peroral prednisolone and warfarin^(R). He has been doing well for 3 years until present. Conclusion：These cases illustrate that systemic corticosteroid may be beneficial for active SLE retinopathy. Additional anticoagulant therapy may be of value with prothrombin time serving as a guide.