両眼に発症した劇症型急性網膜壊死の若年者例

A juvenile case of bilateral fulminant acute retinal necrosis

要約　目的：劇症型急性網膜壊死が両眼に発症した若年者の報告。症例：13歳男子が8日前からの左眼霧視と眼痛で受診した。矯正視力は右0.9，左手動弁で，左眼の前房に炎症所見があった。両眼に網膜静脈の拡張と蛇行，乳頭の発赤・腫脹，後極部の網膜剝離があった。左眼には眼底全面に黄白色滲出斑が多発し，急性網膜壊死と診断した。左眼の網膜剝離が拡大し，初診3日後にシリコーンオイル充塡を併用する硝子体手術と強膜輪状締結術を行った。左眼前房水から水痘帯状疱疹ウイルスが検出された。右眼は保存的に治療し，両眼の網膜は復位した。初診の4か月後に病状は安定し，右眼視力は1.2，左眼視力は0.03であった。結論：急性網膜壊死が疑われる症例では，両眼発症の可能性を考えて対処すべきである。

Abstract.　Purpose：To report a bilaterally affected juvenile patient with fulminant acute retinal necrosis. Case and Findings：A 13-year-old male presented with blurring and pain in the left eye since 8 days before. Corrected visual acuity was 0.9 right and hand motion left. Both eyes showed dilatation of retinal veins, hyperemia and swelling of optic disc, and retinal detachment in the posterior fundus. The left eye showed signs of anterior uveitis and multiple exudates over the whole fundus. These findings led to the diagnosis of acute retinal necrosis. Retinal detachment in the left eye showed rapid progression and had to be treated by vitreous surgery with silicone oil and seleral encircling. Varicella-zoster virus was detected in the aqueous in the left eye. The right eye was treated by conservative means only. The retina became reattached in both eyes with visual acuity of 1.2 in the right eye and 0.03 in the left four months later. Conclusion：This case illustrates that bilateral involvement has to be kept in mind when acute retinal necrosis is suspected.