原田病予後不良例の臨床的検討

Clinical characteristics of Vogt-Koyanagi-Harada disease with poor visual outcome

過去7年間の新鮮な原田病自検例23例を検索した。最終視力との関連で統計学的に解析した項目は，年齢，病型，虹彩炎の程度，髄液細胞数と蛋白濃度，黄斑剥離の持続期間，治療法，副腎皮質ステロイド薬の総量，遷延化，眼合併症である。1.0以上の最終視力が18例36眼（78％）で得られ，0.2未満が3例5眼（11％）であった。片眼視力が0.5以下の5症例を転帰不良群と定義した。転帰不良群中4例が70歳以上で，平均年齢は転帰良好群に比べて有意に高かった（p＜0.05）。黄斑剥離の持続期間は，転帰良好群で14.1±2.6日，不良群で34.4±3.9日であった。白内障と緑内障とは最終視力に影響せず，漿液性網膜剥離以外の眼合併症が転帰不良群に多かった。以上のように，原田病の視力転帰不良に関係する因子は，高齢，30日以上の黄斑剥離の持続，眼合併症であった

We reviewed 23 cases of Vogt-Koyanagi-Harada (VKH) disease seen during the past 7 years. We statis-tically analyzed the following items as related to the final visual acuity: age, type of VKH disease, severity of iritis, cells and protein in the cerebrospinal fluid, duration of macular detachment, method of treatment including corticoster-oid, duration of the disease, and ocular complications. Final visual acuity of 1.0 was obtained in 36 eyes of 18 cases (78%). It was 0.2 or less in 5 eyes of 3 cases (11%). Out of 5 cases, who had final visual acuity of less than 0.5, 4 were aged 70 years or over. Macular detachment had persisted for 34.4±3.9 days in these 5 cases as contrasted to 14.1±2.6 days in the other 18 cases. The final visual acuity was affected by ocular complications and not by cataract or glaucoma. The findings show that poor visual outcome of less than 0.5 was due to advanced age, macular detachment persisting for 30 days or longer, and ocular complications.