視神経乳頭肉芽腫を呈したサルコイドーシスの1例

Optic disc granuloma in a case of sarcoidosis

　サルコイドーシスによる視神経乳頭肉芽腫の1例を経験した。症例は25歳男性のサルコイドーシスで，ステロイドの漸減投与後，左乳頭面上に肉芽腫が出現した。ステロイドを再投与したところ肉芽腫は縮小したが，乳頭周囲の網膜上に新生血管が出現した。その後ステロイドの漸減投与を6か月行い肉芽腫と新生血管は消失した。本症例の新生血管の発生には，不十分なステロイド投与が関与している可能性があり，ステロイドの全身投与は長期にゆっくり漸減すべきであると考えられる。

A 25-year-old male presented with myedesopsia as chief complaint of one month's duration. Both eyes showed signs of iritis, congested retinal veins, retinal periphlebitis and disc edema in both eyes. Systemic examination and laboratory data led to the diagnosis of sarcoidosis. He was treated by topical and systemic corticosteroids. Signs of iritis subsided and systemic prednisolone was discontinued after 16 days. One month later, granuloma started to develop in the left eye. Systemic prednisolone was started 3 weeks later. Disc granuloma decreased in size but disc neovascularization started to grow into the peripapillary retina. Systemic prednisolone in decreasing dosis for six months led to complete regression of granuloma and neovascularization. It appeared that insufficient dosis of systemic corticosteroid resulted in disc neovascular-ization. We advocate administration of corticosteroid on a long-term basis to be tapered gradually.