急性網膜壊死症候群の3症例

Three cases of acute retinal necrosis syndrome

　急性網膜壊死症候群の3例5眼を経験した。症例1の33歳男子および症例2の59歳男子は典型的な桐沢型ぶどう膜炎を呈し，症例2は両眼発症例であった。症例3の49歳女子は特発性間質性肺炎に対するステロイド療法中に右下肢に帯状疱疹が発現し，その後に両眼に壊死性網膜炎が発症した。アシクロビル，γ—グロブリン製剤の全身投与，およびアシクロビルあるいはステロイド灌流下での硝子体切除術，強膜輪状締結術，眼内光凝固術などの治療を行った。症例1では視力0.2を保ったが，症例2および3では汎網脈絡膜萎縮および視神経萎縮となり，予後不良であった。3例4眼に硝子体切除術を行い，採取した硝子体液中の水痘帯状疱疹ウイルスの抗体価が4眼すべてで高値であった。急性網膜壊死症候群の発症には水痘帯状疱疹ウイルスの関与が考えられた。

We observed acute retinal necrosis syndrome in a 49-year-old female and two males aged 33 and 59 years. The males manifested typical clinical fea-tures of Kirisawa-type uveitis. In the female patient, bilateral necrotizing retinopathy developed 6 weeks after herpes zoster in the lower extremity. She had been treated with systemic corticosteroid for interstitial pneumonia for the past 10 months.

We treated the cases with systemic acyclovir and gamma globulin. Four eyes underwent vitrectomy with irrigating solution containing acyclovir and/ or dexamethasone. Visual acuity improved in one eye only. We aspirated the vitreous during vitrectomy in all the 4 eyes. All the aspirates showed elevated titer for varicella-zoster virus antibody by complement fixation. The titer was much higher than that for herpex simplex virus or cytomegalovirus. It appeared that varicella-zoster virus was involved in the pathogenesis of acute retinal necrosis syndrome in the three cases.