慢性網膜壊死の病像を示したサイトメガロウイルス網膜炎の2症例

Two cases of cytomegalovirus retinitis manifesting as chronic retinal necrosis

要約　目的：2013年Schneiderらが提唱した慢性網膜壊死の病像に一致する2例を経験したので報告する。症例1：77歳男性，右眼霧視で初診。初診時，矯正視力は右0.5，左0.9，右眼は高眼圧，虹彩炎，網膜周辺部に白色顆粒状病変，全周に網膜動静脈の閉塞を認めた。前房水PCRでcytomegalovirus（以下，CMV）が検出され，抗CMV薬内服で改善した。症例2：70歳男性，両眼の視野欠損で初診。既往にCMV抗原血症があり，抗CMV薬内服をしていた。初診時矯正視力は両眼0.7。両眼に網膜動脈の白線化，周辺部に顆粒状病変がみられ，進行は緩徐であった。結論：CMV網膜炎では免疫状態にかかわらず網膜周辺部に顆粒状病変，汎網膜閉塞性血管炎が慢性的に進行する病態があり注意を要する。

Abstract.　Purpose：We report two cases of chronic retinal necrosis（CRN）induced by cytomegalovirus（CMV）retinitis. Case1：A 77-year-old man presented with blurred vision in his right eye. Initial examination showed best-corrected visual acuity（BCVA）of 0.5 OD and 0.9 OS. Ophthalmoscopic examination revealed with high intraocular pressure, iritis, panretinal occlusive vasculitis, granular white retinal lesion at the periphery in his right eye. Polymerase chain reaction（PCR）analysis of an aqueous tap revealed CMV-DNA. We diagnosed CRN. He was treated with valganciclovir. Case2：A 70-year-old man reffered to our hospital with complaint of visual field defect in both eyes. He had past history of cytomegalovirus antigenemia, and he was already treated with valganciclovir. Initial examination showed BCVA of 0.7 in both eyes. Ophthalmoscopic examination revealed panretinal occlusive vasculitis, granular white retinal lesion at the periphery in both eyes. There was no change at the last examination. Conclusion：We should pay attention that there are cases of CMV retinitis with peripheral granular retinitis and panretinal occlusive vasculitis despite the immune status.