各種眼疾患における眼内液ヘルペス群ウイルス抗体価および抗体率の検索 眼内ウイルス感染の診断指標として

Diagnostic value of antibody titer and quatient of herpes viruses in intraocular fluids

　抗体率（以下Q値と略す）算出は眼内ウイルス感染が疑われる疾患の病因診断に有用である．診断に対するQ値の評価基準を定める目的で，ヘルペス性ぶどう膜炎（角膜ぶどう膜炎，眼部帯状疱疹に伴う虹彩炎など）13眼と，対照疾患（老人性白内障，硝子体出血，桐沢型ぶどう膜炎以外のぶどう膜炎など）196眼の眼内液（前房水，硝子体液，網膜下液）中のヘルペス群ウイルス抗体価とQ値を比較検討し，以下の結論を得た．

　1．Q値1未満の症例では，眼内ウイルス感染の可能性は極めて低いと思われた．

　2．Q値1以上6未満の症例のうち，眼内液抗体価低値（FAにて10倍）の場合は，眼内ウイルス感染の可能性は低いと思われた．

　3．Q値1以上6未満の症例のうち，眼内液抗体価高値（FAにて40倍以上）であっても血清抗体価が高値のためにQ値が比較的低値をとる症例や，発症ごく早期の症例では，眼内ウイルス感染を疑い，さらにウイルス学的検索が必要と思われた．

　4．Q値6以上の症例では，新鮮例，陳旧例をとわず，眼内ウイルス感染の可能性が極めて高いと思われた．

To determine clinical diagnostic criteria of intraocular viral infection by herpes virus agents, I evaluated the antibody titer in intraocular fluids and circulating blood against, among others, herpes simplex virus, varicella-zoster virus and cytomegalovirus in 13 eyes with herpetic ker-atouveitis or iritis associated with herpes zoster ophthalmicus. Samples of intraocular fluid were either obtained from the aqueous humor, vitreous or subretinal fluid. A similar study was made, as control, in 196 eyes with non-herpetic ocular dis-eases including senile cataract, vitreous hem-orrhage and uveitis. The findings were analyzed with antibody titer in the intraocular fluids and the ratio of the former to that in the plasma, or anti-body quatient, as index factors.

The possibility of intraocular viral infection was very low when the antibody quatient was less than 1. It was also low when the quatient lay between 1 and 6, provided the antibody titer in the intraocular fluids was low, e. g. 1 : 10 by fluorescent antibody technique. Further virological studies seemed to be imperative in eyes with antibody quatient between 1 and 6 whenever the antibody titer was elevated in the intraocular fluids, e. g. more than 1 : 20 by fluorescent antibody technique, when the low anti-body quatient was due to elevated serum antibody titer, or in eyes in the initial phase of infection. For cases with an antibody quatient over 6, the possibil-ity of intraocular viral infection was extremely high, regardless whether the infection was of recent onset or longstanding.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(7) : 801-805, 1988