硝子体中に水痘・帯状疱疹ウイルス抗原が検出されたacute retinal necrosis syndromeの1例

Positive varicella-zoster virus antigen in the vitreous of a case with acute retinal necrosis syndrome

　典型的なacute retinal necrosis syn-drome （ARNS）の42歳男子の症例の硝子体にウイルス学的検索を行い，次のごとき結果を得た．（1）免疫螢光法（直接法）により，硝子体中に水痘・帯状疱疹ウイルス抗原を検出した．（2）硝子体の水痘・帯状疱疹ウイルス抗体価が32倍の高値を示した．（3）ウイルスの分離培養は陰性であった．これらより，ARNSの病因として，水痘・帯状疱疹ウイルスの眼局所感染が示唆された．

A 42-year-old male developed rapid loss of vision in his right eye since 2 weeks before. We diagnosed him as acute retinal necrosis syndrome in its active phase, known as Kirisawa-type uveitis in Japan. We treated him initially with intravenous acyclovir 750 mg/day for 10 days. As vitreous opacity continued to increase, we performed vitrectomy as prophylaxis against retinal detachment 2 weeksafter the patient was seen by us.

The vitreous was aspirated during the initial phase of surgery without dilution by the irrigating solution. In the vitreous aspirate, varicella-zoster virus antigen (VZV) was demonstrated by direct immunofluorescent method. Complement fixation titers were 1 : 32 for VZV, and 1 : <4 each for herpes simplex virus (type 1&2) and cytomegalovir-us. Attempts of virus isolation resulted negative. These findings seemed to strongly indicate that the acute retinal necrosis syndrome is induced by topical infection of the eye by varicella-zoster virus.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(3) : 199-202,1987