典型的皮疹を伴わない水痘・帯状疱疹ウイルスによる虹彩毛様体炎の臨床像の特徴

Clinical features of varicella-zoster iridocyclitis without typical skin eruptions

要約　目的：典型的皮疹を伴わない水痘・帯状ウイルス（VZV）による虹彩毛様体炎の臨床像の報告。対象と方法：過去16か月間のVZV虹彩毛様体炎8例8眼の臨床像を診療歴に基づいて検索した。男性3例，女性5例で，年齢は35〜87歳，平均72歳であった。前房水のPCR法でVZV-DNAが陽性であるか，1年以内に同側の三叉神経枝に帯状疱疹があることを診断基準とした。結果：全例が片眼性で，豚脂様角膜後面沈着物があった。眼圧上昇が5眼にあり，ほとんどが3週間で消炎し，眼圧が正常化した。4眼に角膜浮腫，2眼に軽微な皮疹，3眼で過去に同側の眼部帯状疱疹があった。前房水のPCR検索で，6眼が陽性であり，うち3眼ではこれ以外にVZVに特異な所見がなかった。結論：VZVによる虹彩毛様体炎の主な臨床所見は，片眼性，豚脂様角膜後面沈着物，角膜浮腫，眼圧上昇であった。

Abstract.　Purpose：To report characteristic clinical features of varicella-zoster virus（VZV）iridocyclitis without typical skin eruptions. Cases and Method：This study was made on 8 eyes of 8 patients diagnosed with VZV iridocyclitis by us during the past 16 months. The series comprised 3 males and 5 females. The age ranged from 35 to 87 years, average 72 years. All the cases were either positive for VZV-DNA by PCR of aqueous humor or had the history of herpes zoster skin eruption in the area served by the first branch of trigeminal nerve within the past one year. Results：All the affected eyes showed mutton-fat keratitic precipitates. Intraocular pressure（IOP）was elevated in 5 eyes. IOP normalized within 3 weeks of medication. Corneal edema was present in 4 eyes, mild skin eruption in 2 eyes, and ipsilateral ophthalmic herpes zoster in 3 cases within the past one year. PCR of aqueous humor was positive in 6 eyes including 3 eyes that showed no sign specific for VZV infection. Conclusion：VZV iridocyclitis in the present series was characterized by unilaterality, mutton-fat precipitates, corneal edema and elevated IOP.