原田病に対する治療法についての検討

Treatments of Vogt-Koyanagi-Harada disease

要約　目的：原田病に対する3治療法の効果の比較。対象と方法：過去54か月間に治療した新鮮な原田病25例を検索した。16例にステロイド剤のパルス療法，6例に徐放性ステロイドのテノン囊下注射，3例にパルス療法後に徐放性ステロイドのテノン囊下注射を行った。全例で6か月以上の経過を追った。結果：プレドニゾロンに換算したステロイド総量は，テノン囊下注射群で1,372mg，パルス療法群でその3倍，両者併用群でその5倍であり，有意差があった。初診時視力はテノン囊下注射群が他の2群よりも有意に良好で，最終視力は両者併用群が他の2群よりも有意に悪かった。両者併用群での最終視力は初診時視力よりも改善せず，他の2群では改善した。両者併用群では平均2回の再発があった。結論：ステロイド剤のパルス療法とテノン囊下注射では治療成績に差がなく，後者ではステロイド投与量が少なかった。両者の併用は重篤例に多かった。

Abstract.　Purpose：To evaluate three therapeutic modalities for Vogt-Koyanagi-Harada（VKH）disease. Cases and Methods：This study was made on 25 cases of VKH disease treated in the past 54 months. Sixteen cases were treated by pulsed corticosteroid,6 cases by subtenon injection of slow-release steroid,and 3 cases by pulsed steroid followed by subtenon injection. Cases were followed up for 6 months or longer. Results：Total dosis of steroid averaged prednisolone equivalent of 1,372 mg in subtenon group,about 3 times more in cases treated by pulsed steroid,and 5 times more in cases treated by both. The difference was significant. Initial visual acuity was better in eyes treated by subtenon injection only than others. Cases treated by combination of two methods resulted in poorer final visual acuity than others and had an average of two recurrences. Conclusion：Subtenon injection resulted in the same final outcome as pulsed therapy and required lesser dosis of corticosteroid. Combination of both methods was mainly used in severe cases of VKH disease.