新潟大学における急性網膜壊死症例の検討

A seven-year review of acute retinal necrosis at Niigata University Hospital

要約　目的：新潟大学病院で過去7年間に加療した急性網膜壊死（ARN）の報告。対象と方法：2013年までの7年間に当院を受診したARNの12例12眼を検索し，その治療成績を解析した。男性7例，女性5例で，年齢は25〜76歳，平均53歳であった。結果：全例が片眼発症であった。初診時に採取した前房水から，単純ヘルペスウイルスが3眼，水痘・帯状疱疹ウイルスが9眼で陽性であった。経過中に網膜剝離が7眼に発症し，5眼には発症しなかった。網膜剝離の有無は，ARN発症から受診までの日数とは相関がなかった。網膜剝離の原因は，2眼では増殖膜により牽引，5眼では裂孔原性であった。初診時に硝子体混濁が7眼にあり，うち6眼に網膜剝離が生じた。網膜剝離の全例に対して硝子体手術を行い，シリコーンオイル充塡などを併用した。全7眼で網膜が復位した。結論：当院でのARNはすべて片眼性であった。経過中の網膜剝離発症は，初診時に硝子体混濁のある例に多かった。

Abstract.　Purpose：To present a review of acute retinal necrosis at Niigata University Hospital. Cases and Method：This review was made on 12 eyes of 12 cases who were diagnosed with acute retinal necrosis during 7 years through 2013. The series comprised 7 males and 5 females. The age ranged from 25 to 76 years, average 53 years. Results：All the cases were unilaterally affected. Aspirated aqueous humor was positive for herpes simplex virus in 3 cases and varicella zoster virus in 8 cases. Retinal detachment eventually developed in 7 eyes and not in 5 eyes. Retinal detachment was not correlated with the duration between onset and start of treatment. Retinal detachment was due to proliferative membrane in 2 eyes and was rhegmatogenous in 5 eyes. Vitreous opacity was present in 7 eyes, of which retinal detachment developed in 6 eyes. All the eyes with retinal detachment was treated by vitreous surgery, with additional replacement of vitreous by silicone oil whenever necessary. The retina became reattached in all the 7 eyes. Conclusion：Acute retinal necrosis was unilateral in our series. Retinal detachment was prone to develop in eyes with vitreous opacity.