白内障術後に水痘帯状ヘルペスウイルス虹彩炎を生じ，経過中に交感性眼炎をきたした1例

A case of herpes zoster iritis followed by sympathetic ophthalmia after cataract surgery

要約　目的：白内障術後に水痘帯状ウイルス虹彩炎が生じ，経過中に交感性眼炎が発症した症例の報告。

症例：72歳女性が左眼の虹彩炎と眼圧上昇で紹介受診した。2か月前に両眼の白内障手術を受けていた。

所見と経過：矯正視力は右1.2，左0.7で，眼圧は右8mmHg，左22mmHgであった。左眼にフィブリン形成を伴う虹彩炎があり，術後の眼内炎が疑われた。3日後に眼内レンズの交換と硝子体手術を行い，前房水の細菌培養の結果は陰性であった。初診の11日後に前眼部炎症が再燃し，眼圧が上昇した。左眼の硝子体手術と線維柱帯切除術を行い，前房水から水痘帯状ウイルスDNAが検出された。抗ウイルス薬投与を行い，炎症は改善した。初診から5か月後に脈絡膜剝離と虹彩炎が両眼に生じ，交感性眼炎と診断した。ステロイドの全身と局所投与で2か月後に炎症は消退し，両眼とも1.2の視力を得た。

結論：眼手術の回数が多いほど交感性眼炎が生じやすい可能性を本症例は示している。

Abstract　Purpose：To report a case who developed herpes zoster iritis followed by sympathetic ophthalmia after cataract surgery.

Case：A 72-year-old female was referred for iritis and elevated intraocular pressure in the left eye. She had received cataract surgery in both eyes 2 months before.

Finding and Clinical Course：Corrected visual acuity was 1.2 right and 0.7 left. Intraocular pressure（IOP） was 8 mmHg right and 22 mmHg left. The left eye showed findings of iritis with fibrin formation, suggesting postoperative endophthalmitis. She received exchange of intraocular lens and vitrectomy in the left eye 3 days later. Anterior uveitis recurred 11 days later with elevated IOP. The left eye was treated by trabeculectomy and vitrectomy. Varicella zoster virus DNA was detected in the anterior chamber fluid and antiviral therapy was started. After temporary improvement, both eyes developed uveitis with choroidal detachment. She was diagnosed with sympathetic ophthalmia and received pulse steroid therapy. The inflammation subsided 2 months later with visual acuity of 1.2 in either eye.

Conclusion：This case illustrates that multiple intraocular surgery may be followed by sympathetic ophthalmia.