急性網膜壊死の1治療経験

Therapeutic regimen in a case of acute retinal necrosis

（P−1-71）　急性網膜壊死の病態は，ウイルス増殖による急性網膜炎期，炎症が高度になる網膜壊死期，二次的病変が生じる寛解期の経時的な変化がある。53歳の女性が右眼の霧視を自覚し，その10日後に受診して急性網膜壊死と診断した。前房水から水痘・帯状疱疹ウイルスが検出された。急性期には，アシクロビル極量投与によるウイルス増殖抑制と病巣境界への光凝固を行い，初診6日目からの網膜壊死期にはステロイド薬投与による炎症のコントロール，5週後以降の寛解期の硝子体出血など続発病変に対しては，硝子体手術による観血的治療を順次行った。後極部網膜の温存に成功し，最終視力0.2を得た。本症の治療では，病期に応じた適切な対応が望ましいことを本例は示している。

Clinical manifestations of acute retinal necrosis may differ according to the stage of the disease. It goes through the stage of acute retinitis due to virus proliferation, stage of retinal necrosis due to inflammation, and the stage of remission with secondary lesions. A 53-year-old female noted blurring in her right eye and was referred to us 10 days later. The clinical feature led to the diagnosis of acute retinal necrosis. Varicella zoster virus was isolated from the aqueous. During the acute stage, she was given systemic acyclovir to suppress virus proliferation. Photocoagulation was also performed along the posterior margin of retinal lesions. During the stage of retinal necrosis from 6 days on, she received systemic corticosteroid to bring the inflammation under control. After the disease entered the stage of remission from 5 weeks on, vitrectomy was performed for vitreous hemorrhage. The treatment succeeded in keeping the posterior retina intact with the final visual acuity of 0.2. This case illustrates that specific therapeutic regimen is advocated for each stage of acute retinal necrosis.