乾癬に伴うぶどう膜炎の検討

Review of uveitis associated with psoriasis

要約　目的：乾癬に伴うぶどう膜炎の臨床的な特徴の報告。症例：過去64か月間に受診した乾癬に伴うぶどう膜炎患者5例を診療録の記録から検索した。結果：男性2例，女性3例で，年齢は29～52歳（平均37歳）であった。ぶどう膜炎が3年以上前からある4例では両眼に発症し，罹患期間が短い1例では片眼発症であった。前部ぶどう膜炎が9眼すべてにあり，角膜後面沈着物を伴う非肉芽腫性虹彩毛様体炎があった。前房蓄膿が2例，虹彩後癒着が2例にあった。明らかな中間部または後眼部炎症はなかったが，囊胞様黄斑浮腫が3例に出現し，視力障害が永続化した。HLA検査を行った4例すべてがHLA-A2陽性であった。結論：乾癬に伴うぶどう膜炎は，非肉芽腫性の急性前部ぶどう膜炎の形をとり，高頻度に囊胞様黄斑浮腫が併発し，HLA-A2との相関が高い。

Abstract.　Purpose：To report characteristic clinical features of uveitis in Japanese patients with psoriasis. Cases and Method：This retrospective study was made on 5 patients with uveitis and psoriasis seen during the foregoing 64 months. Results：The series comprised 2 males and 3 females. The age ranged from 29 to 52 years, average 37 years. Both eyes were affected in 4 patients who had had uveitis for 3 years or longer. It was unilateral in one patients with shorter history of uveitis. All the affected 9 eyes showed anterior uveitis with keratic precipitates and nongranulomatous iridocyclitis. Hypopyon or posterior synechia was present in 2 eyes each. While intermediate or posterior uveitis was apparently absent, cystoid macular edema developed in 3 cases resulting in persistent visual impairment. HLA typing showed HLA-A2 in all 4 examined cases. Conclusion：Uveitis in patients of psoriasis is characterized by acute nongranulomatous iridocyclitis, by a high frequency of cystoid macular edema, and by probable relation with HLA-A2.