桐沢型ぶどう膜炎と血漿交換療法

Plasma exchange therapy in acute retinal necrosis (Kirisawa-type uveitis)

　桐沢型ぶどう膜炎（44歳，男性）の急性期病巣に対する血漿交換療法の影響を検討した．血漿交換療法は発症後12病日から1週間に計4回総量5,100ml施行した．交換液には5％アルブミン製剤を使用した。臨床経過のモニターとしては，眼底所見と螢光眼底造影を参考とした．その結果病巣分布は孤立性を呈し網膜動脈炎は軽度で，病巣より末梢の血行はよく保たれ網膜剥離は認めなかった．桐沢型ぶどう膜炎に対する効果の可能性としては，血中の免疫複合体の除去と局所の微小循環改善によると思われた．血漿交換療法は桐沢型ぶどう膜炎の急性期病巣に対する免疫学的治療法として試みる価値があると考えられる．

We treated a 44-old male with unilateral acute retinal necrosis (ARN) with plasma exchange ther-apy (PET). PET was started on 12 days after onset of the disease and was repeated 4 times during a one-week session. A total of 5, 100ml of the plasma was replaced by 5% human albumin electrolyte solution. Regression of exudative retinal lesions started 12 days after initiation of the therapy. Dur-ing the follow-up over a 23-month period, the initi-ally exudative lesions stayed well isolated, the reti-nal periarteritis remained stationary in area, micro-circulation of the retina was maintained well even peripheral to the lesions and no retinal detachment had set in.

The apparently beneficial effect of plasma ex-change therapy on acute retinal necrosis seemed to be due to removal of immune complexes in cir-culating blood and to an improved retinal circula-tion.