片眼の急激な近視化と脈絡膜の肥厚がOCT検査でわかり早期診断に至ったVogt-小柳-原田病の1例

A case of Vogt-Koyanagi-Harada disease with unilateral acute myopia and thickened choroid as the initial manifestation

要約　目的：近視化と脈絡膜肥厚が光干渉断層計（OCT）でわかり，早期診断に至ったVogt-小柳-原田病（原田病）の1例を報告する。

症例：41歳，女性。起床時に左眼視力低下を自覚し原因精査依頼にて紹介受診。視力右1.2，左0.5（1.0×−3D），検眼鏡所見に異常はなく左眼は−3D矯正で視力が改善した。OCTで黄斑部網膜の異常はなく，経過観察としたが所見を見直したところ脈絡膜の肥厚に気づき翌日前眼部OCTにて左眼の浅前房化を確認した。原田病を疑い蛍光眼底撮影を施行し，左眼網膜に点状多発性の蛍光漏出と，右眼脈絡膜に過蛍光を認め，非典型的であるが原田病と診断した。

結論：OCT検査は診察でわかりにくい浅前房や脈絡膜肥厚を証明することが可能で原田病の早期診断に有用である。

Abstract　Purpose：To report a case of Vogt-Koyanagi-Harada disease（Harada disease）who showed unilateral acute myopia and thickening of the choroid by optical coherence tomography（OCT）as the earliest clinical manifestation.

Case and Findings：A 41-year-old was referred to us for blurring in the left eye since waking up the same day. Visual acuity was 1.2 without correction in the right eye and 0.5（1.0×−3.0D）in the left. OCT showed thickening of the choroid. When seen the next day, the left eye showed shallow anterior chamber. Fluorescein and indocyanine green angiography showed leakage and staining in both eyes characteristic for Harada disease.

Conclusion：This case illustrates that shallow anterior chamber with myopia may be the initial manifestation of Harada disease. OCT was essential in the early diagnosis in the present case.