片眼のVogt-小柳-原田病治療中に僚眼にMPPEを合併したと考えられる1例

A case of multifocal posterior pigment epitheliopathy during treatment for Vogt-Koyanagi-Harada disease in the fellow eye

要約　目的：片眼のVogt-小柳-原田病（原田病）の治療中に，僚眼に多発性後極部網膜色素上皮症（MPPE）が発症した症例の報告。

症例：46歳の男性が左眼の霧視で受診した。

所見と経過：矯正視力は右1.2，左0.1で，左眼の黄斑部に漿液性網膜剝離があった。フルオレセイン蛍光眼底造影と光干渉断層計などの所見から原田病と診断した。ステロイドパルス療法などで左眼の網膜剝離は1か月後に寛解し，視力は1.2に回復した。2か月後に右眼に漿液性網膜剝離が生じた。ステロイドパルス療法には反応せず，その4か月後の蛍光眼底造影で6か所の漏出点があった。MPPEと診断し，5か所の漏出点を光凝固した。2か月後に右眼の網膜剝離は消失した。

結論：片眼の原田病の治療としてステロイド薬を全身投与したことが，僚眼のMPPEの原因となった可能性がある。

Abstract　Purpose：To report a case of multifocal posterior pigment epitheliopathy（MPPE）during treatment for Vogt-Koyanagi-Harada（VKH）disease in the fellow eye.

Case：A 46-year-old male presented with blurring of vision in the left eye.

Findings and Clinical Course：Corrected visual acuity was 1.2 right and 0.1 left. The left eye showed serous retinal detachment in the macular area. Fluorescein angiography and optical coherence tomography（OCT）showed findings compatible with the diagnosis VKH disease. Pulse therapy with corticosteroid was followed by resolution of retinal detachment in the left eye one month later. The right eye developed serous detachment in the macular area 2 months later. It failed to respond to repeated pulsed corticosteroid therapy. Fluorescein angiography 4 months after onset showed 6 points of dye leakage, leading to the diagnosis of MPPE. Photocoagulation to the points of leakage was followed by resolution of fundus lesion 2 months later.

Conclusion：The present case suggests that systemic corticosteroid therapy for apparently unilateral VKH disease may have induced MPPE in the fellow eye.