実質型角膜ヘルペスにおけるステロイド非投与例の検討

Corticosteroid-free treatment of herpetic stromal keratitis

　39例40眼の実質型角膜ヘルペスに対し，ステロイド投与を行わず抗ヘルペス剤を中心とする治療を試み，以下の成績を得た．

（1） IDUのみで軽快傾向のみられたものは22例23眼（59％）であり，残りの症例にはF₃T, IDC, Ara-A等を投与した．

（2）上記の治療に抵抗性であったもの，再発を繰り返した症例に対しては，レバミゾールの内服を併用した．投与量は週1回100mgとし，10〜17週用いた．

（3）中断の1例を除く全例に軽快をみ，33例（87％）で視力の改善がみられた．初診より治癒までの期間は平均70日であった．

（4）治癒と判定後の平均観察期間は15.6カ月で，この期間内における再発は27.3％であった．

We treated 40 eyes (39 cases) of herpetic stromal keratitis without resorting to corticosteroid. We employed topical IDU as the first choice. In cases in which IDU proved futile, other agents in-cluding F3T, IDC or Ara-A were subsequently em-ployed. In intractable or relapsing cases, peroral levamisole was used at the dose of 100mg once a week over 10 to 17 weeks.

In all cases except one, in which treatment was discontinued, we observed disappearance of active keratitis or iritis. Visual acuity had improved in 33 cases (87%). Healing was achieved after an average of 70 days. There was no significant difference in the duration till clinical healing between disciform and interstitial keratitis. During the mean follow-up pe-riod of 15.6 months, keratitis recurred in 27% of the eyes.

These findings indicate that herpetic stromal keratitis can be treated effectively without the use of corticosteroid. The chief merit of this mode of treatment seems to lie in avoidance of addiction or dependence on corticosteroid.