高知大学附属病院眼科における視神経炎の治療の検討

Therapeutic outcome of optic neuritis at Kochi Medical School Hospital

要約　目的：視神経炎に対する治療成績の報告。対象と方法：過去3年間に当科で視神経炎として加療した17例を対象とした。男性8例，女性9例で，年齢は9〜83歳，平均54歳である。初診時に，全例で血清中の抗aquaporin-4（AQP4）抗体値を測定した。結果：抗AQP4抗体は，4例で陽性，13例で陰性であった。陽性群は男性1例，女性3例で，年齢は53〜79歳，平均62歳であった。3例が両眼の視神経炎であり，3例に過去の視神経の既往があった。ステロイドパルス療法は，抗AQP4抗体陽性群の2例と陰性群の2例で無効であり，陽性群2例では血漿交換で視機能が改善した。最終視力は，抗AQP4抗体陽性群7眼中5眼で0.1以下であり，陰性群15眼中12眼で1.0以上，2眼で0.1以下であった。結論：ステロイドパルス療法が奏効しない抗AQP4抗体が陽性の視神経炎には，血漿交換療法が有効であった。抗AQP4抗体陰性群にも，ステロイドパルス療法の無効例があった。

Abstract.　Purpose：To report the outcome of treatment for optic neuritis. Cases and Method：This retrospective study was made on 17 cases who were diagnosed with optic neuritis by us during the past 3 years. The series comprised 8 males and 9 females. The age ranged from 9 to 83 years, average 54 years. All the cases were tested for anti-aquaporin-4（AQP4）in the serum. Results：Anti-AQP4 antibody was positive in 4 cases and negative in 13. The positive cases comprised one male and 3 females. The age ranged from 53 to 79 years, average 62 years. Three cases were bilaterally affected. Three cases had past episode of optic neuritis. Pulsed corticosteroid therapy was futile in 2 cases each of anti-AQP4 antibody positive and negative group. Plasma exchange therapy was effective in 2 cases that failed to respond to corticosteroid. Final visual acuity was less than 0.1 in 5 out of 7 eyes positive for anti-AQP4, It was 1.0 or over in 12 out of 15 eyes negative for anti-AQP4. Conclusion：Plasma exchange therapy was effective in cases that were positive for anti-AQP4 and that failed to respond to corticosteroid therapy. Corticosteroid therapy was ineffective in some cases negative for anti-AQP4.