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要約 目的:後天性眼トキソプラズマ症の臨床的特徴の報告。
対象と方法:東京医科大学病院眼科で後天性眼トキソプラズマ症と診断された24例28眼を対象に,眼底病変の局在,フルオレセイン蛍光眼底造影(FA)所見,血清トキソプラズマIgM抗体,治療内容,再発の回数,視力予後について診療録をもとに検討した。
結果:病変は後極部に最も多く18眼を占め,Edmund-Jensen型は2眼,その他が17眼であった。20例にFAを施行し,black centerを伴う輪状過蛍光が10眼(50%)で,網膜血管炎が20眼中12眼にみられた。18例で血清トキソプラズマIgM抗体の測定が行われ,そのうち9例(50%)で上昇が確認された。治療はアセチルスピラマイシン内服のみが10例,同薬とステロイドの内服が5例,同薬とステロイドの局所注射が2例,クリンダマイシンの内服のみが2例で,その他が4例であった。経過観察中,22眼では一度も再発せず,2眼で1回,1眼で2回,3眼で3回の再発があった。治療の前後で矯正視力に有意差はなく,最終矯正視力0.8以上が26眼中15眼(58%)を占めた。
結論:後天性眼トキソプラズマ症は再発を繰り返すこともある疾患であるが,治療に対する反応は良好で,視力予後も比較的予後良好であった。血清トキソプラズマIgM抗体の上昇は診断に重要であるが,IgM抗体の上昇が確認できなくても後天性眼トキソプラズマ症の可能性を否定できるものではない。
Abstract Purpose:To report the clinical features of acquired ocular toxoplasmosis.
Cases and Method:This retrospective study was made on 28 eyes of 24 patients who were diagnosed with acquired ocular toxoplasmosis by us in the past 21 years. The series comprised 12 males and 12 females. The age averaged 51.6±12.5 years.
Findings:Fundus lesions were located in the posterior fundus in 18 eyes. Peripapillary lesion chatracteristic for Edmund-Jensen type was present in 2 eyes only. Fluorescein angiography was performed in 20 eyes. Black center with ring-shaped hyperfluoscence was present in 10 eyes(50%). Serum level of IgM against toxoplasma was positive in 9(50%)out of 18 measured cases. Ten cases were treated by systemic acetylspiramycin alone and 7 patients with additional corticosteroid. Two patients received clindamycin alone and 4 cases were treated by other medications. During follow-up, 22 eyes showed no relapse. Two eyes showed single relapse, one eye showed 2 relapses, and 3 eyes showed 3 relapses. Best corrected visual acuity remained unchanged before and after treatment. It was 0.8 or better in 15 eyes(58%)at the final evaluation.
Conclusion:Acquired ocular toxoplasmosis responded well to treatment despite relapse in a few cases. Increase in serum toxoplasmosis IgM level is important but not essential in the diagnosis.
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