脈絡膜病変を合併した眼部帯状ヘルペスの1例

A case of herpes zoster ophthalmicus with choroidal involvement

　散在性の脈絡膜病変を同側眼に合併した，眼部帯状ヘルペスの1症例を報告した．

　症例　は基礎疾患を何ら有しない62歳男性で，特徴的な顔面の皮疹，表層性角膜炎，虹彩萎縮を伴った虹彩毛様体炎，続発緑内障に加えて，発症2カ月後に眼底に散在性の滲出斑が出現し，しだいに拡大した．検眼鏡および蛍光眼底造影において，病巣内に脈絡膜血管が認められ，網膜色素上皮とともに脈絡膜毛細血管板にも萎縮が存在することが示された．病変の主座は脈絡膜毛細血管板を中心とした脈絡膜と思われたが，その原因がウイルスによる直接的炎症なのか，血管炎による循環障害が主体なのかは不明であった．

　眼部帯状ヘルペスにおいては，眼球摘出を余儀なくされる重症例でなくても脈絡膜病変を合併しうることが示された．

A 62-year-old healthy male presented with facial eruptions, superficial keratitis, iridocyclitis with iris atrophy and secondary glaucoma in his left side. He was diagnosed as herpes zoster ophthalmicus. Two months after the initial onset, white spots appeared in the left fundus and increased in size during the following 4 months. Funduscopy and fluorescein angiography showed baring of the choroidal vessels and atrophy of the choriocapillaris in these lesions. The retinal pigment epithelium seemed to be intact.

These findings seemed to suggest that the choroid was the main site of affection by herpes zoster. The choroidal involvement was thought either due to direct inflammation or to ischemia as a consequence of vas-culitis.

Rinsho Ganka (Jpn J Chn Ophthalmol) 40(8) : 945-948, 1986