アシクロビルと硝子体手術が奏効した桐沢型ぶどう膜炎の1例

Systemic acyclovir and vitrectomy was effective in a case of acute retinal necrosis

　片眼の著明な前部および後部ぶどう膜炎をきたし，桐沢型ぶどう膜炎が強く疑われ，前房水中に免疫螢光抗体法により水痘・帯状疱疹ウイルス抗原陽性細胞が検出された1症例に対し，アシクロビルの点滴静注を施行し，さらに，灌流液中にアシクロビルを混入しての硝子体切除術および網膜剥離予防のための強膜輪状締結術を行った。その結果，初診時視力20cm指数弁が治療開始4か月後には0.9，治療開始後1年11か月の時点で1.0まで回復し，その間，白内障を発症したものの，ぶどう膜炎の再発，網膜剥離の発症等はみていない。桐沢型ぶどう膜炎の病因として水痘・帯状疱疹ウイルスの関与が推測され，またその治療にはアシクロビル点滴静注，硝子体切除術などの治療が重要と考えられた。

A 39-year-old female presented with severe visual impairment, ocular pain and hyperemia in her right eye of 3 weeks' duration. We diagnosed her as Kirisawa-type uveitis, or acute retinal ne-crosis. The aqueous aspirate from the affected eye showed varicella-zoster virus positive cells by direct immunofluorescence method. She was treat-ed with intravenous acyclovir, 45mg/kg/day, for 2 weeks. We performed vitrectomy along with intravitreal infusion of acyclovir and prophylactic scleral buckling 3 weeks after initially seen by us. The inflammation subsided without recurrence or secondary retinal detachment. The visual acuity recovered from finger counting initially to 0.9 10 weeks after surgery and to 1.0 another 20 months later.

This case suggests that varicella-zoster virus may be one of the causative agents for acute retinal necrosis. Intensive treatments with systemic acy-clovir and vitrectomy may be crucial in saving the affected eye.