上皮型ヘルペス角膜炎症例の実質型ないし内皮型への移行に関する検討

Investigation of the background of clinical shift from epithelial herpetic keratitis cases to stromal or endothelial types

要約　目的：上皮型ヘルペス角膜炎が実質型ないし内皮型へ移行する際の，臨床的背景の関連について検討したので報告する。

対象と方法：2019年1月〜2021年3月に福岡大学病院眼科を受診し，上皮型ヘルペス角膜炎と診断された症例55例55眼について，実質型ないし内皮型へ移行した症例（移行群）と，上皮型のみで寛解した症例（寛解群）に分け，性差，年齢，経過観察期間，ヘルペス角膜炎の既往，角膜移植の既往，発症時ステロイド点眼・内服の使用，糖尿病・アトピー性皮膚炎の既往について差がないか，診療録を用いて後ろ向きに検討した。

結果：寛解群は41例41眼（男性23例，女性18例），平均（±標準偏差）年齢66.1±19.0歳，移行群は14例14眼（男性9例，女性5例），平均年齢62.6±16.2歳であった。両群に差は認めなかった。平均経過観察期間は，寛解群は542.9±394.7日，移行群では291.3±309.2日と寛解群で有意に長かった（p＜0.05）。ヘルペス角膜炎の既往は寛解群41眼中11眼（27％），移行群14眼中10眼（71％）と移行群に有意に多く（p＜0.01），平均既往回数も寛解群で0.73回，移行群で2.57回と移行群で有意に多かった（p＜0.01）。角膜移植の既往は寛解群41眼中19眼（46％），移行群14眼中1眼（7％）と寛解群に有意に多かった（p＜0.01）。発症時ステロイド点眼・内服，糖尿病・アトピー性皮膚炎の既往について両群に有意差は認めなかった。

結論：ヘルペス角膜炎の既往が複数回ある症例では，上皮型，実質型，内皮型のどの病型でも再発する可能性があり，角膜移植既往症例では上皮型の再発に終始し，実質型もしくは内皮型への移行が生じにくいことが示唆された。

Abstract　Purpose：To report on the background of clinical shift from epithelial herpetic keratitis to stromal or endothelial keratitis.

Materials and Methods：From January 2019 to March 2021, 55 patients 55 eyes who were diagnosed with epithelial herpetic keratitis at Fukuoka University Hospital were divided into two groups：cases cured only as the epithelial type（remission group）and cases who changed to stromal or endothelial keratitis types during the clinical course（transition group）. Patient medical records were retrospectively evaluated for sex；age；follow-up period；use of corticosteroids locally or systemically at the onset of primary epithelial lesion；and history of herpetic keratitis, keratoplasty, diabetes mellitus or atopic dermatitis.

Results：The remission group consisted of 41 patients 41 eyes with a mean（±standard deviation）age of 66.1±19.0 years. The transition group consisted of 14 patients 14 eyes with a mean age of 62.6±16.2 years, with no significant difference between the two groups. The mean follow-up period was 542.9（±394.7）days in the remission group and 291.3（±309.2）days in the transition group, which was significantly longer in the remission group（p＜0.05）. History of herpes keratitis was significantly more in the transition group（10/14 eyes, 71％）than in the remission group（11/41 eyes, 27％）（p＜0.01）. The average number of recurrences of herpetic keratitis was 0.73 in the remission group and 2.57 in the transition group, showing a significant inter-group difference（p＜0.01）. The history of keratoplasty was significantly more in the remission group（19/41 eyes, 46％）than in the transition group（1/14 eyes, 7％）（p＜0.01）. No significant difference was observed between the two groups regarding the use of corticosteroids locally or systemic routes, and the history of diabetes mellitus or atopic dermatitis.

Conclusions：Cases of herpetic keratitis with multiple recurrences usually tend to transition to other types of keratitis, such as endothelial or stromal types. In our study, we also found that in patients with a history of keratoplasty, the tendency to transition to stromal or endothelial types of keratitis is less, and cases are more likely to recur as epithelial type.