糸状菌による角膜真菌症における病型と予後の検討

Typing and prognosis of keratomycosis caused by filamentous fungi

　過去4年間の角膜真菌症の自験例17眼を解析した。すべて片眼発症で，男性10例，女性7例であり，全例で病巣部の角膜擦過物の培養または検鏡で糸状菌と診断されている。前房蓄膿またはendothelial plaqueが初診時にあり，病巣が角膜全層に及ぶ10眼と，これらがなく，病巣が角膜表層に限局する7眼とに大別できた。前者を「全層型」，後者を「表層型」と仮称する。表層型の視力転帰は全層型よりも良好であり，経過中に角膜穿孔が生じて角膜移植を必要とした5眼はいずれも全層型であった。糸状菌による角膜真菌症を，全層型と表層型の2病型に分類することは，視力予後の推定に有効であると結論される。

　We reviewed 17 cases of keratomycosis seen during the past 4 years. The series comprised 10males and 7 females. All were unilaterally affected. In all the cases,filamentous fungi were identified from the corneal scrapings either directly or after culture. We could classify the cases into two types based on biomicroscopic findings at the initial visit. Ten eyes had either hypopyon or endothelial plaque. The lesion involved all the corneal layers. Seven eyes had neither hypopyon nor endothelial plaque. The lesion involved the superficial corneal layer only. We tentatively named the former─all layer type'and the latter as─superficial layer type'. The visual outcome was better in superficial than in all layer type. Five eyes that needed keratoplasty due to corneal perforation belonged to the all layer type. It is useful to classify keratomycosis caused by filamentous fungi into two types in the assessment of visual prognosis.