原田病の経過と予後—副腎皮質ホルモン剤の全身投与を行わなかった症例について

Course and prognosis of Harada's disease without systemic corticosteroid therapy

　原田病に対するステロイド大量投与による治療法の評価を再検討するために，ステロイド剤の大量投与を行わない20症例につき，その経過と予後を検討した．20例中3例が遷延化し，他の3例が再発したが，最終観察時ではこれら6例の中2例のみが，活動性病変を示し，他は治癒した．視力予後は1.0以上が17例34眼，0.5〜0.9が3例5眼，0.3が1例1眼，0.8以上は18例36眼であり，原田病に対してはステロイド剤の全身投与を行わなくても，遷延化あるいは再発することなく，予後良好な経過をとる症例が大部分であることが明らかになった．このことから，原田病に対するステロイド大量療法は再検討されるべきである．

We evaluated the clinical course of 20 selected cases of Harada's disease during the foregoing 42-month period. All the cases were treated with con-ventional means including topical corticosteroid but without systemic corticosteroids.

Cure of the uveitis resulted in 14 cases 6 monthsafter initial occurrence. In the remaining 6 cases, symptoms were continuing in 3 and the diease recurred later in the other 3. An eventual cure resulted in 4 of these 6 cases. The symptoms pro-longed further in the other 2.

The final visual acuity was 1.0 or more in 34 eyes (17 cases) and 0.8 or more in 36 eyes (18 cases).The visual acuity was between 0.5 and 0.9 in 5 eyes (3 cases) and was 0.3 in 1 eye.

Above findings indicate that permanent recov-ery was attained in 70% of cases with Harada'sdisease 6 months after onset without systemic corti-costeroid therapy. The final visual outcome was favorable. These results point to the need to ree-valuate the routine use of massive corticosteroid in Harada's disease.