サルコイドーシスぶどう膜炎での結膜生検の有用性

Usefulness of conjunctival biopsy in sarcoidosis uveitis

　初診時に眼科臨床所見からサルコイドーシスぶどう膜炎が疑われ結膜生検を行った34例62眼を対象に，結膜生検の有用性を検討した。最終診断での内訳は臨床診断群（A群）が19例，サルコイドーシスが疑われたが臨床診断群の基準を満たさなかった症例（B群）8例，サルコイドーシス以外のぶどう膜炎の確診例（C群）7例であった。生検標本は点眼麻酔後，下結膜円蓋部中央付近の結膜を約2×4mm切除した結膜片を用いた。陽性率はA群58％，B群，C群は0％であった。隅角結節，豚脂様角膜後面沈着物がある症例，発症早期でステロイド未使用例は生検陽性率が高い傾向があった。結膜生検は，サルコイドーシスの組織学的診断には有用であり，初診時に他の侵襲の大きい生検に先んじて施行するべきことを改めて提唱したい。

We performed conjunctival biopsy in 62 eyes of 34 uveitis patients in whom sarcoidosis was suspected from initial eye findings. The series comprised three groups. Sarcoidosis was diagnosed in 19 patients who satisfied the criteria of the disease with systemic manifestations (Group A). Sarcoidosis was suspected but failed to satisfy the criteria in 8 patients (Group B). Sarcoidosis was initially suspected but was eventually ruled out in 7 patients (Group C). The specimens for biopsy were obtained from the center of the inferior conjunctival fornix. Findings were positive in 11 cases (58%) in Group A, and were negative in all the cases in Group B and C. Positive findings were more frequent in eyes with chamber angle nodules, mutton-fat keratic precipitates, or in the early stage of uveitis without prior treatment with corticosteroid. The findings show that conjunctival biopsy is useful in the diagnosis of ocular sarcoidosis and is to be performed before resorting to more invasive diagnostic approaches.