ステロイドパルス療法が奏効した血管閉塞型SLE網膜症の1例

Corticosteroid pulse therapy was effective in a case of lupus retinopathy with retinal vascular occlusions

（18-P1-19）　網膜動静脈の閉塞をきたし予後が極めて不良とされる血管閉塞型SLE網膜症にステロイドパルス療法を施行し，有効であった1例を経験した。症例は27歳の女性で，左眼霧視を自覚して受診。矯正視力は右1.2，左手動弁。螢光眼底造影にて右眼は散在性の毛細血管床閉塞とその周囲の血管炎所見，左眼は黄斑部を含んだ広範囲な毛細血管床閉塞と動静脈における造影剤の途絶の所見がみられた。ステロイド内服療法を行うも右眼血管炎は増悪し，視力0.4と低下したためステロイドパルス療法を行った。治療後右矯正視力は1.2に回復し，血管炎ならびに毛細血管床閉塞の改善，ERGの正常化がみられた。

　毛細血管床の閉塞が広範囲に及ぶ前の段階でのステロイドパルス療法は有効であると考えられる。

A 27-year-old woman presented with blurring in her right eye of one week's duration. She had been diagnosed as systemic lupus erythematosus (SLE) 10 years before. Her corrected visual acuity was 1.2 right and hand motion left. Fluorescein angiography showed disseminated capillary nonperfusion with vasculitis in the right eye. The left eye showed extensive capillary nonperfusion involving the macula and poor perfusion in major retinal vessels. Peroral prednisolone was followed by aggravation of vasculitis in the right retina with reduction of visual acuity to 0.4. Corticosteroid pulse therapy induced improvement in retinal vasculitis, capillary nonperfusion, electroretinogram and visual acuity to 1.2 in the right eye. This case illustrates the efficacy of corticosteroid pulse therapy for SLE retinopathy before capillary nonperfusion has become extensive.