一眼発症3年後他眼にも発症しアシクロビルの点滴静注が有効であった網膜血管炎の1例

Systemic acyclovir was effective in a case of recurrent retinal angitis

　38歳，男性の慢性腎不全血液透析症例にみられた両眼の閉塞性網膜血管炎について報告した。左眼は，半側網膜中心静脈閉塞症を発症後，短期間に同側の眼動脈の閉塞，ついで眼内炎を併発して失明した。右眼は，左眼発症に遅れて約3年後，網膜中心静脈分枝の広範な白鞘化を呈する樹氷状血管炎の発症をみたが，アシクロビル点滴静注が著効し，右眼眼病変の病因として単純ヘルペスあるいは水痘・帯状ヘルペスウイルスの関与が示唆された。左眼発症時の眼底写真を再検討した結果，左眼にも右眼同様網膜静脈分枝の一部に白鞘化を認めた。左右の眼底所見に若干の差はみられるものの，両眼同一の原因により発症したことを疑わせた。

A 38-year-old male had been under treatment with hemodialysis for chronic renal failure for the past 2 years. He manifested hemicentral retinal vein occlusion with venous sheathing in his left eye. The eye became blind due to endophthalmitis and neovascular glaucoma. Carotid artery angiography showed occlusion of the ipsilateral ophthalmic artery. Impairment of vision occurred in the right eye 3 years later. Funduscopy showed sheathing and engorgement of retinal veins, retinal edema and perivascular hemorrhages, simulating frosted-branch retinal angitis. These changes started to improve 3 days after initiation of intravenous acy-clovir, 750 mg per day. The visual acuity improved from the initial level of 0.1 to 1.5. The total T-lymphocytes in the peripheral blood and blast-genesis stimulated by phytohemagglutinin were lower than normal limits during the phase of recov- ery of the disease. Our observation suggests that herpes virus group may cause retinal venous throm-bosis and frosted-branch retinal angitis.