和歌山県立医科大学附属病院での最近5年間の小児視神経炎の検討

A five-year review of optic neuritis in children at Wakayama Medical University Hospital

要約　目的：過去5年間の和歌山県立医科大学附属病院眼科（当科）における小児視神経炎の臨床像，自己抗体陽性率，治療法，治療反応性，視力予後について検討すること。

対象と方法：2018年3月までの5年間に，当科で視神経炎と診断・治療した小児5例（男性2例，女性3例，平均年齢9±2.3歳）を対象とした。診断はInternational Pediatric MS Study Groupによる疾患定義に基づいて行った。

結果：臨床像は急性散在性脳脊髄炎に伴うものが2例，clinically isolated syndromeが1例，多発性硬化症（MS）が1例，特発性視神経炎が1例であった。抗MOG抗体陽性例は2例，抗AQP4抗体陽性例は0例であった。両眼発症は2例，再発は2例に認められた。全症例でステロイドパルス療法にて視力改善を認めた。抗MOG抗体陽性例2例に免疫グロブリン大量療法を併用し，そのうち1例で免疫吸着療法を併用した。平均logMAR矯正視力は初診時1.6±0.8，最終−0.06±0.2であった。

結論：小児視神経炎では治療によって最終的に視力は改善した。小児例では視神経だけでなく，頭蓋内病変や脊髄病変で再発をきたす例もあるので，小児科と連携して経過観察をしていく必要がある。

Abstract　Purpose：To report cases of pediatric optic neuritis seen by us during 5 years through 2018.

Cases：There were 5 cases, comprising 2 males and 3 females. The age ranged from 6 to 12 years, average 9 years. Three cases were unilaterally and two were bilaterally affected. They were diagnosed after the definition by International Pediatric MS study Group.

Findings and Clinical Course：Two cases were associated with acute disseminated encephalomyelitis. One case each was diagnosed as clinically isolated syndrome, as idiopathic optic neuritis, and as multiple sclerosis. Anti-MOG antibody was positive in 2 cases. Anti-aquaporin 4 antibody was negative in all the cases. Steroid pulse therapy was effective in all the cases, with 2 cases who showed recurrence. Two cases positive for anti-MOG antibody were also treated by high-dose gamma globulin, with immunosorbent therapy in one case. Visual acuity in logMAR averaged 1.6±0.8 initially and 0.06±0.2 after treatment.

Conclusion：Visual acuity improved in all cases of pediatric optic neuritis. There were recurrences involving not only the optic nerve but also the intracranial portion and spinal cord.