高度の視野異常を合併した網膜下線維性増殖を伴う汎ぶどう膜炎の1例

Markedly affected visual field in a case of panuveitis with subretinal fibrosis

要約　目的：高度の視力と視野障害を呈した網膜下線維性増殖を伴う汎ぶどう膜炎の症例の報告。

症例と経過：29歳女性が両眼の視力低下で，ぶどう膜炎として紹介受診した。父親が悪性リンパ腫であった。矯正視力は右1.0，左手動弁で，限界フリッカ値は右38Hz，左測定不能であった。両眼の前房と硝子体内に細胞が浮遊し，乳頭の鼻側に弧状の網膜下線維性病変があった。耳側と周辺視野に狭窄があり，網膜電位図でb波の減弱があった。ステロイドパルス療法で，視力は右1.2，左1.0になり，限界フリッカ値は右41Hz，左40Hz，周辺視野は正常化し，網膜電位図は正常波形になった。

結論：網膜下線維性増殖を伴う汎ぶどう膜炎に対するステロイドパルス療法で，視力低下と視野障害は，網膜機能とともに劇的に改善した。

Abstract　Purpose: To report a case of panuveitis with subretinal fibrosis manifesting markedly impaired vision and visual field.

Case: A 29-year-old female presented with impaired visual acuity in both eyes.

Findings: Best-corrected visual acuity was 1.0 in the right eye and hand motion in the left. Critical flicker frequency（CFF）was 38 Hz right and nonrecordable left. Both eyes showed cells in the aqueous and the vitreous. Subretinal fibrosis was present nasal to the disc. Visual field was constricted in both eyes. Electroretinogram（ERG）was almost nonrecordable. Corticosteroid pulse therapy was followed by improved visual acuity to 1.2 right and 1.0 left. Peripheral visual field and ERG became normal.

Conclusion: Corticosteroid pulse therapy for panuveitis was followed by dramatic improvement of retinal functions including vision and visual field.