トリアムシノロンテノン囊下投与が有効であったと考えられたIRVAN症候群の1例

A case of IRVAN（idiopathic retinal vasculitis, aneurysms, and neuro-retinitis）responsive to sub-Tenon triamcinolone acetonide injection

要約　目的：IRVAN症候群の軽症例で，トリアムシノロンテノン囊下注射（STTA）に反応したと考えられる症例の報告。

症例：69歳，女性。右眼視力低下を主訴に受診した。

所見と経過：矯正視力は右0.5，左1.2で，両眼とも前房に軽度の炎症と硝子体中細胞を認め，両眼底に網膜細動脈瘤が多発し，右眼は網膜細動脈瘤から黄斑部への滲出を認めた。1か月後に右眼の黄斑部の滲出がいったん吸収され，右眼視力1.2となった。その1か月後に新たな網膜細動脈瘤が出現し，右眼は黄斑部の滲出により視力が0.5に低下した。軽減傾向がみられないためSTTAを行ったところ，右眼の黄斑部の滲出は吸収され，右眼視力は0.7に改善，STTA後10か月の時点で再発を認めていない。

結論：IRVAN症候群の軽症例で，黄斑部の滲出性病変にSTTAが奏効したと考えられる。

Abstract　Purpose：To report a mild case of idiopathic retinal vasculitis, aneurysms and neuro-retinitis（IRVAN）that responded to sub-Tenon triamcinolone acetonide injection（STTA）.

Case：A 69-year-old woman was referred to us for impaired vision in the right eye.

Findings and Clinical Course：Best-corrected visual acuity（BCVA）was 0.5 in the right and 1.2 in the left eye. In both eyes, mild iritis was seen in the anterior chamber and a few cells were found in the vitreous. Multiple retinal arterial aneurysms were detected in both eyes, and macular exudation from an aneurysm was seen in the right eye. One month later, the macular exudation disappeared and BCVA became 1.2. Another month later, new aneurysms appeared and BCVA of the right eye again reduced to 0.5 due to macular exudation. Since it remained unchanged, we performed STTA to the right eye. After the injection, the macular exudation decreased, resulting in visual acuity of 0.7. There was no recurrence 10 months after STTA.

Conclusion：STTA appears to have been effective for macular exudation in a mild case of IRVAN syndrome.