抗菌薬治療で良好な経過をたどった急性網膜内層炎の2例

Two cases of acute inner retinitis responded to treatment with antibiotics

要約　目的：抗菌薬治療で良好な経過をたどった急性網膜内層炎の2例の報告。

症例：症例1は79歳，女性。右眼の飛蚊症を自覚し，近医で前房炎症，硝子体混濁を指摘され，ステロイド点眼を開始されるも右眼の眼底出血と軟性白斑が出現したため，当院へ紹介となった。右眼の矯正視力0.6，眼底にびまん性硝子体混濁，網膜白色病巣，出血を認め，光干渉断層計（OCT）で白斑部位に一致して網膜内層病変を認めた。1か月のミノサイクリン200mg/日の内服により白斑は消失し，視力は0.9まで改善した。

　症例2は60歳，男性。前医で右眼の前房炎症，両眼の網膜動脈分枝閉塞症，両眼の網膜白色病巣，さらに蛍光眼底造影検査で右眼の網膜血管炎を指摘され，精査加療目的で当院へ紹介となった。矯正視力は右1.2，左0.8であった。症例1と同様に，OCTで左眼の黄斑近傍の白斑部位に一致して網膜内層病変を認めた。デキサメタゾン結膜下注射およびミノサイクリン200mg/日とクラリスロマイシン400mg/日の内服により，2か月半で炎症は消失し，両眼とも1.2まで視力改善を得た。

結論：網膜内層に白色病巣を伴うぶどう膜炎に対して抗菌薬治療が奏効する可能性がある。

Abstract　Purpose：We report two cases of acute inner retinitis that responded to treatment with antibiotics.

Cases：Case 1 is a 79-year-old woman presented with floater in her right eye. Slit-lamp examination showed anterior chamber inflammation in her right eye. The patient's best corrected visual acuity（BCVA）was 0.6 in the right eye. Fundus examination revealed diffuse vitreous opacity, retinal white lesions, and retinal hemorrhage. Optical coherence tomography（OCT）passing through the white lesion revealed a focal area of inner retinal thickening with hyperreflectivity. She was treated with oral minocycline（200 mg/day）for one month. The retinal lesions disappeared and her BCVA improved to 0.9.

Case 2 is a 60-year-old man presented with persistent intraocular inflammation that did not respond to steroid eye drops. His BCVA was 1.2 in the right eye and 0.8 in the left eye. Slit-lamp examination showed anterior chamber inflammation. Fundus examination showed retinal white lesions and branch retinal artery occlusion in both eyes. Fluorescein angiography showed retinal vasculitis. Similar to case 1, OCT showed an inner retinal layer hyperreflectivity consistent with the elevated retinal lesion in the left eye. He was treated with oral minocycline（200 mg/day）, clarithromycin（400 mg/day）and subconjunctival injection of dexamethasone. After 2.5 months of medication, the inflammation disappeared and his BCVA improved to 1.2 in both eyes.

Conclusion：Antibiotic therapy may be successful in uveitis with white lesions in the inner retina.