投影図からトレパンの位置と大きさを算出し良好な視力を得た自己角膜回転移植の1例

Restored visual acuity in a case of autokeratoplasty using size and position of trephining calculated from corneal photograph

　48歳男性の左眼に木片があたり，角膜中央部から周辺2方向に向かう裂傷が生じた。受傷の当日に裂傷を縫合したが，瞳孔領に角膜混濁が残った。7か月後の視力は0.2であり，自己角膜回転移植を企画した。瞳孔領に広い透明領域を得るために，前眼部写真から移植片の部位を選んだ。同様な方法に加えて縫合糸の幅を考慮し，角膜トレパンの直径を7.5mmに決定した。手術により角膜白斑は周辺部に移動し，透明な光学部が瞳孔領に確保できた。裸眼視力は2年後に1.0になり，以後3年間良好な視力を維持している。今回の方法は，自己角膜回転移植で有効な視機能を得るために有用であった。

　A 48-year-old male was hit by a flying piece of wood on his left eye. The cornea ruptured in two directions from the center of the cornea. The rupture was sutured the same day. Visual acuity was 0.2 seven months after the accident due to scarring in the central cornea. We planned autokeratoplasty to improve the visual acuity. We analyzed the corneal photograph to obtain as wide a transplanted area as possible. We then chose 7.5mm as the size of corneal trephining using the same method and taking the width of the suture into consideration. The central cornea became transparent after surgery. Visual acuity improved to 1.0 two years later. The patient is doing well for another three years until present. The above method was useful in predicting the size and position of the transparent pupillary area after autokeratoplasty. It also resulted in good postoperative visual acuity.