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要約 目的:難治性のVogt-小柳-原田病(VKH)に対し,トリアムシノロンのテノン囊下注射を併用して加療した症例の報告。
症例:62歳の男性が1か月前からの両眼視力低下で受診した。既往歴として高血圧があった。
所見と経過:矯正視力は右0.3,左0.2で,両眼の前房に炎症の所見があり,両眼に乳頭の腫脹と漿液性網膜剝離があった。VKHと診断し,メチルプレドニゾロンのパルス療法を行った。乳頭腫脹と網膜剝離は消退したが,5か月後に左眼の網膜剝離が発症増悪した。再度のパルス療法は効果が乏しく,内服に切り替えたのちに敗血症が発症した。ステロイドの投与量を減らし,左眼にトリアムシノロンのテノン囊下注射を行い,網膜剝離は消退した。さらに5か月後に増悪があり,左眼にトリアムシノロンのテノン囊下注射と硝子体内注射を行い,網膜剝離は消退した。網膜下の析出物が線維化し,発症から4年後の現在,右1.0,左0.1の視力である。
結論:再発遷延化したVKHに,トリアムシノロンの局所注射が奏効した。
Abstract Purpose:To report a case of recurrent and refractory Vogt-Koyanagi-Harada(VKH)disease that responded to local injection of triamcinolone.
Case:A 62-year-old male presented with poor visual acuity in both eyes since one month before.
Findings and Clinical Course:Corrected visual acuity was 0.3 right and 0.2 left. Both eyes showed signs of inflammation in the anterior chamber. Both eyes showed disc swelling and serous retinal detachment. Under the diagnosis of VKH disease, he was treated by pulsed corticosteroid therapy. Disc swelling and retinal detachment subsided in both eyes. Retinal detachment recurred in the left eye 5 months later. Pulsed steroid therapy was futile. Treatment with peroral corticosteroid was followed by septicemia. After reduction in dosage of corticosteroid, the left eye received subtenon injection of triamcinolone. Retinal detachment in the left eye disappeared. Retinal detachment recurred another 5 months later, but was controlled after intravitreal and subtenon injection of triamcinolone. Due to persistent fibrinization of subretinal exudate, visual acuity remained 1.0 right and 0.1 left for 4 years until present.
Conclusion:Topical injection of triamcinolone was effective for recurrent and refractory VKH disease.
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