サイトメガロウイルス網膜炎に対するganciclovirによる治療

Treatment of cytomegalovirus retinitis with systemic ganciclovir

　肺癌に対する化学療法が発症の原因と考えられる両眼性のサイトメガロウィルス網膜炎の症例に，ganciclovirによる治療を行った。体重kg1日当り10mg投与による初期治療で病変の進行は阻止できたが，投与中止により右眼に網膜炎が再発し，体重kg 1日当り6mgの維持療法が必要となった。また，左眼は維持療法中に網膜剥離を発症したが，硝子体手術とsilicone oil注入で網膜は復位した。右眼に対しては，ganciclovir減量による網膜炎の再発と網膜剥離の発症を防ぐ目的で，瘢痕病巣とその周囲をアルゴンレーザーで凝固した。

A 59-year-old male developed bilateral cytomegalovirus retinitis after sustained systemic cyclophosphamide therapy for lung cancer. Visual impairment in the left eye had been present for the foregoing 10 weeks. The right eye was asymptomatic. We treated the patient with sys-temic ganciclovir at the dosis of 10 mg/kg. Improvement in visual acuity and fundus lesion resulted 3 weeks after initiation of treatment.Maintenance therapy with 6 mg/kg of ganciclovir was effective after the cytomegalovirus retinitis recurred in the right eye after discontinuation of ganciclovir.Retinal detachment with atrophic holes developed in the left eye 4 months after first seen by us. We performed pars plana vitrectomy with silicone oil injection with success. Atrophic areas in the right fundus were treated by argon laser photocoagulation, The final visual acuity was 20/20 right and hand motion left.