硝子体中の水痘・帯状ヘルペスウイルス抗体価高値を示した非定型的桐沢型ぶどう膜炎の1例

A case of acute retinal necrosis manifested high varicella-zoster virus antibody titer in the vitreous

　急性の激しいぶどう膜炎と強い硝子体混濁で発症し，眼底透見不能のまま網膜剥離をきたした症例に対し，硝子体中のウイルス学的検索を行った．

　本症例では，硝子体の水痘・帯状ヘルペスウイルス抗体価が64倍の高値を示し，血清の値と比較した抗体率では135と有意の上昇を示した．術後眼底所見では閉塞性動脈炎や網膜浸出斑を認めず，本症例を非定型的桐沢型ぶどう膜炎と診断した．

　桐沢型ぶどう膜炎は種々の病態を呈することが示唆され，原因不明のぶどう膜炎において，眼内液のウイルス抗体率を算出することにより，確定診断上有力な情報が得られると考えられた．

A 44-year-old male developed rapid loss of vision in the left eye associated with acute uveitis and severe vitreous opacity. Intravenous acyclovir and oral aspirin was futile in preventing further exacer-bation of vitreous opacity with the visual acuity reduced to hand motions. On day 50 of the disease, retinal detachment was detected by echography. We then performed vitrectomy, membrane peeling andsilicone oil tamponade. The aspirated vitreous showed high varicella-zoster virus (VZV) antibody titer (×64) and antibody quotient (135).

These findings suggested topical infection by VZV as the cause of the disease. As this case lacked typical findings of acute retinal necrosis syndrome (ARNS) such as obliterative vasculitis or yellow -white retinal exudates, we diagnosed the case as atypical ARNS.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(8) : 937-940,1988