Immune recovery uveitisに発症した黄斑上膜の1例

A case of immune recovery uveitis manifesting epiretinal membrane

要約　目的：後天性免疫不全症候群（AIDS）患者が免疫再構築ぶどう膜炎（IRU）を発症，黄斑上膜を形成し，硝子体手術を行った症例の報告。症例：25歳男性，右眼の視力低下，視野狭窄を自覚し受診した。所見：視力右（0.5），右眼に網膜血管炎を認め，サイトメガロウイルス（CMV）網膜炎を疑った。血液検査でAIDSと判明しCMV網膜炎と診断した。バルガンシクロビル内服と抗HIV療法（ART）を開始しCMV網膜炎は沈静化し，視力（0.9）と改善した。2か月後にIRUを発症し，その後，黄斑上膜の形成を認めた。黄斑の牽引が強くなり，視力（0.06）と低下したため硝子体手術を行った。術後6か月経過し，黄斑部の下方偏位は残存するも，視力（0.4）と改善した。結論：ARTによりAIDS患者の生命予後は改善したがIRUを発症し，硝子体手術を施行する症例の増加が予想される。

Abstract.　Purpose：To report a case of acquired immunodeficiency syndrome（AIDS）who underwent vitrectomy for epiretinal membrane formation following immune recovery uveitis（IRU）. Case：A 25-year-old man was referred to our facility, complaining of decreased vision and visual field in the right eye. Findings：His corrected visual acuity was 0.5 in the right eye, and cytomegalovirus（CMV）retinitis was suspected due to retinal vasculitis. Serologic test revealed that the patient developed AIDS and confirmed the diagnosis of CMV retinitis. Treatment with valganciclovir and antiretroviral therapy（ART）was initiated. CMV retinitis regressed, and his right corrected visual acuity improved to 0.9. Two months later, he developed IRU followed by epiretinal membrane formation. Vitrectomy was performed because macular traction intensified, and visual acuity decreased to 0.06. At 6 months postoperatively, although the macula remained dislocated inferiorly, visual acuity improved to 0.4. Conclusion：While survival of AIDS patients have been improved with the introduction of ART, the number of patients who develop IRU and require vitrectomy is likely to increase.