急性網膜壊死における原因ウイルスと臨床経過

Identification of causative virus and clinical course of acute retinal necrosis

要約　目的：前房水のpolymerase chain reaction（PCR）で診断が確定した急性網膜壊死8例の報告。対象と方法：過去44か月間に急性網膜壊死と診断した8例9眼を対象とした。男性7例8眼，女性1例で，年齢は13～87歳，平均48歳である。所見：前房水のPCRで，単純ヘルペスウイルス（HSV）が3例，水痘帯状疱疹ウイルス（VZV）が5例で陽性であった。HSVが陽性の1例では体幹の帯状疱疹の既往があった。網膜剝離は9眼中HSV 2眼，VZV 4眼を含む6眼に生じた。結論：急性網膜壊死の起因ウイルスでは，VZVが多かった。HSVによる急性網膜壊死では，若年者に生じ，長期間後に僚眼に発症するなどの非特異的経過をとることがある。

Abstract.　Purpose：To report 8 cases of acute retinal necrosis（ARN）diagnosed by polymerase chain reaction（PCR）. Cases and Method：This retrospective study was made on 9 eyes of 8 cases diagnosed with ARN in the past 44 months. The series comprised 8 eyes of 7 males and one female. The age ranged from 13 to 87 years, average 48 years. Findings：PCR of the aqueous showed simple herpesvirus（HSV）in 3 cases and varicella zoster virus（VZV）in 5 cases. One case with positive HSV had previous history of herpetic encephalitis. Two cases with positive HSV had had ARN in the fellow eye. One case of positive VZV had had herpes zoster in the trunk. Retinal detachment developed in 6 eyes including 2 eyes with positive HSV and 4 eyes with positive VVZ. Conclusion：VZV was the most frequent causative virus for ARN. ARN secondary to HSV was characterized by manifestation at younger age and bilateral involvement.