若年性関節リウマチに併発した多発性網膜下滲出斑を伴うぶどう膜炎の1例

Iridocyclitis with subretinal flecked lesions in a case of juvenile rheumatoid arthritis

　若年性関節リウマチに併発した多発性網膜下滲出斑を伴うぶどう膜炎で，長期の経過観察を行った1例を報告する。

　症例は11歳女児。初診時，両眼に虹彩毛様体炎を認め，眼底には視神経乳頭の充血と浮腫，後極部から中間周辺部にかけて1／3〜2／3乳頭径大の黄白色の網膜下滲出斑を散在性に認めた。螢光眼底造影では乳頭および網膜血管からの色素漏出がみられ，また滲出斑の一部は初期から後期まで境界不鮮明な低螢光を示した。副腎皮質ステロイドの点眼，内服およびアスピリンの内服を行い，虹彩毛様体炎と滲出斑の消失を得た。3年後に再発を一度認めたが，その後9年間は再発がない。眼底には色素を伴う瘢痕病巣，硬性ドルーゼン様網膜下沈着物を残している。

A 11-year-old girl presented with decreased visu-al acuity, iridocyclitis and elevated intraocular pressure in both eyes. She had been suffering from pauciarticular type of juvenile rheumatoid arthritis since the age of 5 years. Ophthalmoscopy showed multiple yellowish-white flecked deposits in the subretinal space. Systemic corticosteroid and aspi-rin resulted in disappearance of iridocyclitis, disc edema and subretinal lesions. Bilateral panuveitis recurred 3 years later. Fluorescein angiography during the initial phase of the disease showed leak-age of dye from the disc and retinal vessels. Sub-retinal flecked lesions appeared as hypofluorescent patches. These subretinal lesions showed dye stain-ing over the following 9 years.