Fuchs虹彩異色性虹彩毛様体炎の臨床的特徴および本態

Clinicopathological study of Fuchs' heterochromic iridocyclitis

　最近5年間に典型的なFuchs虹彩毛様体炎の12症例を経験した．症例は1年から8年間観察したが，慢性虹彩毛様体炎の経過を示し，小さい白色の角膜後面沈着物，虹彩紋理のびまん性ないし斑紋状の消失，前房内の小数の細胞をみたが，毛様充血，虹彩後癒着はなく，また虹彩異色はあまり目立たず，4眼のみが患眼で明るかった．Browneyeでは虹彩異色はあらわれにくい．白内障は全例にみられ，7眼に白内障手術が行われ，経過は良好であった．中年者の原因不明の片眼白内障に本症の存在を考慮すべきである．2眼に緑内障の合併をみ，1眼は手術を要した．8眼の白内障，および緑内障手術時に採取した周辺虹彩組織を電子顕微鏡的に観察した．虹彩実質への軽度の炎症性細胞（リンパ球，形質細胞）の浸潤と虹彩血管の内腔の狭細化，血管壁の変性像がみられ，本症の病因として虹彩血筥の異常が関与していると考えられた．

We observed 12 cases of Fuchs' iridocyclitis during the past 5-year period. The ages ranged from 31 to 67 years. Both sexes were equally in-volved. The condition was unilateral in all cases.

No obvious heterochromia of the iris was seen in 6 of the 12 eyes. All the affected eyes, though, manifested atrophy of the iris : an important clini-cal sign at the diagnosis of this disorder.

Seven eyes were treated by cataract surgery with uneventful postsurgical course. Iris specimens were obtained from 8 eyes during surgery for cataract or glaucoma and were subjected to electron micro-scopic studies. All the eight specimens showed minimal lymphocyte and plasma cell infiltrations in the stroma and the perivascular space. Narrow-ing of vascular lumen or degenerative changes of stromal vessels were seen in 5 eyes.

While the pathogenesis of this syndrome is still far from clear, our findings point to the probable predominant role played by degenerative changes of iris vessels reflecting the disruption of blood-iris barrier.