15年間のVogt-小柳-原田病の検討

A fifteen-year review of Vogt-Koyanagi-Harada disease

要約　目的：過去15年間の原田病自験例の報告。対象と方法：2009年までの15年間に初期治療を行った原田病117例を対象とした。男性42例，女性75例で，年齢は15～76歳（平均45歳）である。結果：初期治療として，ステロイド大量漸減療法を55例，ステロイドパルス療法を53例，ステロイド点眼を7例，ステロイド内服を2例に行った。再発と再燃は33例にあり，うち22例が遷延化した。最終視力0.5以下は18眼にあり，再発，再燃または遷延例に多かった。複数回の再発または再燃と夕焼け眼底は，ステロイド大量漸減療法を行った症例に多かった。結論：再発，再燃または遷延化した原田病では，最終視力が不良になる可能性が高い。複数回の再発または再燃と夕焼け眼底は，ステロイドパルス療法よりもステロイド大量漸減療法を行った症例に多かった。

Abstract.　Purpose：To present a review of Vogt-Koyanagi-Harada（VKF）disease in the past 15 years. Cases and Method：This retrospective study was made on 117 cases of VKH disease who were first seen by us during 15 years through 2009. The series comprised 42 males and 75 females. The age ranged from 15 to 76 years,average 45 years. Results：Fifty-five cases were initially treated by high-dose corticosteroid followed by tapering,53 cases by pulsed corticosteroid,7 cases by topical corticosteroid,and 2 cases by peroral corticosteroid. The disease recurred or relapsed in 33 cases,22 of which resulted in protracted course. Eighteen eyes resulted in final visual acuity of 0.5 or less. These eyes were mainly those with recurrence or relapse of the disease. Cases treated by high-dose corticosteroid followed by tapering often resulted in multiple recurrence and sunset-glow fundus. Conclusion：Recurrence and protracted course are major factors for poor visual outcome. Multiple recurrences and sunset-glow fundus were more frequent in cases treated by high-dose corticosteroid followed by tapering than pulsed corticosteroid.