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要約 背景:定量PCR法を用いて経過観察した単純ヘルペスウイルス角膜内皮炎の1例報告。症例と所見:70歳男性。繰り返す右眼角膜浮腫と眼圧上昇のため当科へ紹介された。初診時の右眼矯正視力は0.2。耳側角膜に扇状の実質浮腫がみられ,拒絶反応線様の線状の角膜後面沈着物を認めた。角膜内皮炎と臨床診断し,約50μlの前房水を採取した後,PCR法を施行した。HSV-DNAは,定性PCR法で陽性,かつ定量PCR法では4.7×103 copies/sample検出された。アシクロビル内服・眼軟膏,ベタメタゾン点眼で初診4週後に角膜実質浮腫は軽減した。初診3か月後,角膜浮腫は消失した。再度前房水を採取し定量PCR法を施行したが,HSV-DNAは検出されなかった。結論:定量PCR法がHSV角膜内皮炎の治療法を検討するうえで重要であった。
Abstract. Purpose:To report a case of herpes simplex virus(HSV)corneal endotheliitis guided by polymerase chain reaction(PCR)of the aqueous in the diagnosis and treatment. Case:A 70-year-old male presented with recurrent corneal edema and elevated intraocular pressure in the right eye. Findings:The right eye showed severe stromal edema involving the temporal sector of the cornea, leading to the diagnosis of corneal endotheliitis. About 50μ1 of the aqueous was aspirated. Quantitative PCR showed 4.7×103 copies/sample of HSV-DNA, and negative findings for varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, or HHV-7 virus. He was treated by topical and systemic acyclovir, and topical betamethasone. The corneal stromal edema decreased after 4 weeks of treatment and dissolved 3 months later. PCR of aqueous showed no HSV-DNA. Conclusion:Quantitative PCR was useful in the diagnosis and treatment of corneal endotheliitis by HSV. To our best knowledge, this is the first report on quantitative PCR in corneal endotheliitis.
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