急性網膜壊死に対する硝子体手術を施行後10か月で再発した1例

A recurrent case of acute retinal necrosis at 10 months after the vitrectomy

要約　目的：急性網膜壊死（ARN）に対する硝子体術後に10か月経過してから再発を生じた症例の報告。

症例：58歳の女性。右眼の視力低下と霧視を自覚し，近医にて右眼のARNの疑いにて福岡大学病院眼科に紹介された。視力は右（0.5），左1.5。右眼の角膜裏面に豚脂様沈着物を認め，前房内炎症，眼底には乳頭腫脹，周辺部網膜の白濁を認めた。PCR検査により水痘帯状疱疹ウイルスを認め，ARNと診断。硝子体手術，シリコーンオイル注入術を2回行い炎症は鎮静化した。その10か月後にシリコーンオイル抜去の予定であったが入院時に右眼の霧視を自覚。視力は手動弁に低下し，前眼部に高度の炎症所見を認めた。ARNの再燃と判断し，バラシクロビル内服，プレドニゾロン内服にて炎症所見は軽快し，視力は（0.1）に改善した。

結論：ARNに対する硝子体手術およびシリコーンオイル注入術を施行してから10か月後に再発を生じる例は稀である。ARNでは硝子体術後も注意深い経過観察を要する。

Abstract　Purpose：To report a case of recurrence of acute retinal necrosis 10 months after vitrectomy.

Case：A 58-year-old woman noticed blurred vision in the right eye and was referred to our department with a suspicion of acute retinal necrosis. Visual acuity was 0.5 in her right eye and 1.5 in her left eye. A mutton fat keratic precipitate, inflammation in the anterior chamber, swelling of the optic disc in the fundus, and yellowish white retinal lesions of the peripheral retina were observed. Varicella-zoster virus was confirmed by polymerase chain reaction（PCR）and she was diagnosed with acute retinal necrosis. Vitrectomy and silicone oil injection were performed twice to reduce the inflammation. She became aware of blurred vision of the right eye again 10 months later. Corrected visual acuity was reduced to hand motion, and a high degree of inflammation was observed in the anterior segment of the eye. She was diagnosed as having a recurrence of acute retinal necrosis, and oral administration of valacyclovir and steroid alleviated the inflammation, after which visual acuity recovered to 0.1.

Conclusion：This was a rare cases of recurrence of acute retinal necrosis 10 months after vitreous surgery and silicone oil injection. This illustrates that patients with acute retinal necrosis require careful follow-up after vitreous surgery.