抗アクアポリン4抗体陽性視神経炎7例の臨床経過

Clinical course in seven cases of anti-aquaporin-4 antibody-positive optic neuritis

要約　目的：抗アクアポリン4抗体陽性の視神経炎10眼7例の報告。症例：鳥取大学附属病院眼科で過去6年間に視神経炎と診断した27例を対象とした。男性12例，女性15例，発症年齢は平均48歳であった。うち7例（26％）で抗アクアポリン4抗体が陽性で，うち3例では両眼発症であった。片眼に発症した1例を除く6例9眼に対し，ステロイドパルス治療を行った。片眼に発症した4例では，3例が初診時視力が0.02以下で，最終視力は2例が1.0以上，2例が指数弁以下であった。両眼に発症した3例6眼では，初診時視力が4眼で指数弁以下であり，最終視力は2眼が1.0以上，4眼が0.05以下であった。治療前後の視力に有意差はなかった。片眼発症の4例にはプレドニゾロン内服を行い，再発または他眼の発症はなかった。両眼に発症した3例では，まず片眼に発症し，それぞれ4か月，8か月，8年の後他眼に発症した。他眼の発症時にはプレドニゾロン内服は中止していた。結論：抗アクアポリン4抗体陽性の視神経炎では，ステロイドパルス治療後のプレドニゾロン内服が，視力の転帰にある程度の効果があった。

Abstract.　Purpose：To report the clinical course of 7 cases with anti-aquaporin-4 antibody-positive optic neuritis. Case：This retrospective study was made on 27 cases who were diagnosed with optic neuritis at the Tottori University Hospital. The series comprised 12 males and 15 females. The age averaged 48 years. Seven cases in the series were positive for anti-aquaporin-4 antibody, including 3 bilaterally involved cases. Six cases were initially treated by steroid pulse therapy. Out of 4 unilaterally affected cases, initial visual acuity was less than 0.02 in 3 eyes. Final visual acuity was 1.0 or over in 2 eyes and below counting fingers in 2 eyes. Out of 3 bilaterally affected cases, initial visual acuity was less than counting fingers in 4 eyes. Final visual acuity was better than 1.0 in 2 eyes and less than 0.05 in 4 eyes. There was no significant difference between initial and final visual acuity in the whole series. There was no recurrence or involvement of the fellow eye in 4 unilateral cases while under systemic prednisolone therapy. In 3 bilateral cases, the fellow eye developed optic neuritis after 4 months, 8 months and 8 years respectively. Systemic prednisolone had been discontinued at the time of involvement of fellow eye. Conclusion：Peroral prednisolone appears to affect the visual outcome in anti-aquaporin-4 antibody-positive optic neuritis.