ステロイド大量療法に抵抗した視神経炎に対する血漿交換療法

Plasmapheresis for optic neuritis refractory to corticosteroid pulse therapy

要約　目的：血漿交換療法を行った視神経炎の成績の報告。対象と方法：視神経炎の急性増悪時にステロイド大量療法を行っても効果が乏しく，二重膜濾過血漿交換療法を行った連続8例12眼を対象とした。全例が女性で，年齢は30～72歳（平均48歳）である。病型は視神経脊髄炎が6例9眼，特発性視神経炎が2例3眼であった。全例で抗aquaporin-4（AQP4）抗体を検索した。治療効果は視力とGoldmann視野で判定した。結果：抗AQP4抗体は5例が陽性で3例が陰性であった。血漿交換療法後に7例9眼で2段階以上の視力の改善が得られた。抗AQP4抗体が陰性の症例では全例が改善し，陽性であった5例のうち再発回数が多かった2例3眼では視機能が改善しなかった。結論：二重膜濾過血漿交換療法は，抗AQP4抗体が陰性である視神経に奏効した。抗AQP4抗体が陽性で，過去の再発回数が多い視神経炎には，効果が限られていた。

Abstract.　Purpose：To report the outcome of plasmapheresis for optic neuritis. Cases and Method：This retrospective study was made on consecutive 12 eyes of 8 patients who received double filtration plasmapheresis for exacerbation of optic neuritis. All the cases had failed to respond to pulsed corticosteroid therapy. All the cases were females. They were aged from 30 to 72 years,average 48 years. Optic neuromyelitis was present in 9 eyes of 6 cases and idiopathic optic neuritis in 3 eyes of 2 cases. All the cases were examined for anti-aquaporin-4（anti-AQP-4）antibody. Effect of treatment was evaluated with visual acuity and Goldmann visual field as parameters. Results：Anti-AQP-4 antibody was positive in 5 cases and negative in 3 cases. Plasmaphoresis was followed by increased visual acuity by 2 lines or more in 9 eyes of 7 cases. All the cases with negative anti-AQP-4 antibody showed improvement. There was no improvement in 3 eyes of 2 cases who had had repeated recurrences and who were among 5 cases positive for anti-AQP-4 antibody. Conclusion：Double filtration plasmapheresis was effective for optic neuritis in cases with negative anti-AQP-4 antibody. The treatment was of limited value in cases with positive anti-AQP-4 antibody and with past history of repeated recurrences.