桐沢型ぶどう膜炎の重症度を決める因子

Prognostic factors in acute retinal necrosis syndrome

　桐沢型ぶどう膜炎の自験例22例26眼を対象とし，最終視力と諸因子との関係を統計的に検討した。最終視力不良となった症例では，網膜滲出斑は急速に拡大し，後極まで及び，最終的に広範囲となり，硝子体網膜癒着を伴っているものが多かった。また，①網膜動脈炎が視神経乳頭よりびまん性に生じていること，②網膜電図のa，b波高の低下，③末梢血中の免疫複合体の上昇，の3点は，予後不良であることを初診時に予測する指標になりうると考えられた。性別，発症地，発症年月，病因ウイルスの種類，初診時の前房炎症の程度，眼圧，豚脂様角膜後面沈着物の有無血沈，CRP，血清IgG量と最終視力との関連はなかった。

We reviewed 22 patients with acute retinal ne-crosis syndrome to identify the early clinical fac-tors related with eventual poor visual outcome. The series included 18 unilateral and 4 bilateral cases.

Patients with poor visual outcome were char-acterized by rapid extension of retinal exudates, wider involvement of the retina including the poste-rior fundus, and presence of vitreoretinal adhesion. We identified the following 3 clinical features at the initial stage of the disease as indicators of poor visual outcome : retinal arteritis or arterial obliter-ation encroaching the disc area, reduced amplitude of a and b waves by electroretinogram, and ele-vated levels of circulating immune complex.

Following factors were unrelated to the visual outcome : sex, place of onset, season of the year, nature of pathogenic viral agent i. e. herpes simplex or varicella-zoster, intensity of aqueous flare or keratic precipitates, intraocular pressure, eryth-rocyte sedimentation rate, levels of C-reactive protein and serum IgG during the early phase of the disease.