急性網膜壊死に対しアメナメビル内服を使用した3例

Three cases of acute retinal necrosis treated by peroral amenamevir

要約　目的：急性網膜壊死（ARN）に対してアメナメビル（AMNV）の経口投与で加療した3例の報告。

対象と方法：過去11か月間にARNと診断され，AMNVの経口投与を行った3例を対象とした。すべて片眼性で，46歳男性，72歳男性，49歳女性であった。1例は10年前に生体腎移植を受け，免疫抑制薬を使用中であった。

所見と経過：全例の前房水が水痘・帯状ウイルスに陽性であった。腎移植の既往がある1例では，アシクロビルとAMNVの長期内服で寛解した。2例目は網膜病変が周辺に限局する早期例で，AMNV内服のみで治癒した。3例目では病変が黄斑部に及び，アシクロビルとAMNVの内服を行い，予防的に硝子体手術を行った。その後新たな裂孔が生じ，再手術を必要とした。3例ともAMNVによると思われる副作用はなかった。

結論：水痘・帯状ウイルスが原因となるARNに対し，AMNVの経口投与が奏効したと推定される。

Abstract　Purpose：To report 3 cases who were treated by peroral amenamevir for acute retinal necrosis.

Cases：We reviewed 3 cases of acute retinal necrosis treated during the past 11 months. Two were males and one was a female. They were aged 46, 49 and 72 years respectively. All were unilaterally affected. One had received living renal transplantation 10 years before and had been treated by immunosuppressive agents.

Findings and Clinical Course：The aqueous humor was positive for varicella zoster virus after polymerase chain reaction in all the 3 cases. One case receiving immunosuppressive agents was treated by peroral acyclovir and amenamevir and resulted in cure. In the second case in the early stage of acute retinal necrosis, peroral amenamevir alone resulted in resolution. The third case was treated by acyclovir and amenamevir because of involvement of the macular area. The affected eye was treated by prophylactic vitreous surgery. Additional surgeries became necessary due to multiple retinal breaks before cure was attained. There was no side effect due to amenamevir.

Conclusion：Peroral amenamevir appeared to be effective for acute retinal necrosis associated with varicella zoster virus.