急性網膜壊死の治療成績

Outcome of treatment for acute retinal necrosis

要約　目的：急性網膜壊死の自験例の臨床像と治療成績の報告。対象：過去15年間に診断した急性網膜壊死12例15眼を対象とした。男性9例，女性3例で，年齢は19から72歳，平均47歳であった。所見と経過：病因は単純ヘルペスウイルス7例，水痘・帯状疱疹ウイルス5例であった。全例にアシクロビルを投与し，1眼に網膜光凝固，1眼に強膜輪状締結術，11眼に強膜輪状締結術と硝子体手術を行った。手術回数は平均2.6回で，10眼にシリコーンオイルを併用した。最終視力は0.7以上が6眼（40％），0.6から0.1が2眼（13％），0.1未満が7眼（46％）であった。結論：当科での急性網膜壊死は単純ヘルペスウイルスによるものが多く，網膜剝離が高頻度に続発した。重症または劇症の症例には，強膜輪状締結術とシリコーンオイルを併用する硝子体手術が有効であった。

Abstract.　Purpose：To report the clinical features and therapeutic outcome of acute retinal necrosis. Cases：This retrospective study was made on consecutive series of 15 eyes of 12 cases during 15 years through 2009. The series comprised 9 males and 3 females. The age ranged from 19 to 72 years,average 47 years. Findings and Clinical Course：The causative factor was identified as herpes simplex virus in 7 cases and varicella zoster virus in 5 cases. All the cases received acyclovir. One eye was treated by photocoagulation,one by scleral encircling,and 11 eyes by scleral encircling and vitreous surgery. Surgery was performed at an average of 2.6 times. Silicone oil tamponade was performed in 10 eyes. Final visual acuity was 0.7 or better in 6 eyes（40％）,0.6 to 0.1 in 2 eyes（13％）,and less than 0.1 in 7 eyes（46％）. Conclusion：Acute retinal necrosis in our series was mainly due to herpes simplex virus. Retinal detachment was a major complication. Scleral encircling and vitreous surgery with silicone tamponade was often effective for acute or fulminant cases.