治療的全層角膜移植術が奏効した角膜真菌症の1例

Therapeutic penetrating keratoplasty was effective in a case of fungal keratitis

要約　47歳男性が当初は左眼の細菌性角膜潰瘍，その後，角膜真菌症としての治療を受けた。改善がなく，発症から4か月後に当科を紹介され受診した。視力は光覚弁で，角膜潰瘍底に硬い石灰様沈着物があり，前房蓄膿と強い結膜充血があった。薬物治療の限界と判断し，治療的全層角膜移植術を行った。病巣部の組織には，石灰様沈着物の後方に真菌が高密度で集簇していた。術後の経過は良好で，炎症の再燃や，白内障以外の重篤な合併症はなく，術後1年に0.5の矯正視力を得た。適切な薬物治療で消炎しない真菌性角膜潰瘍に対して治療的全層角膜移植術が奏効した症例である。

Abstract.　A 47-year-old man had been under treatment for bacterial keratitis initially and later for fungal keratitis in his left eye. After the condition did not respond to treatment,he was referred to us 4 months after onset. The visual acuity in the affected eye was light perception. Calcified deposits were present within the corneal ulcer as well as hypopyon and conjunctival hyperemia. As further medical treatments did not appear to be indicated,we performed therapeutic penetrating keratoplasty. Histopathological studies showed dense accumulation of fungal mass posterior to the calcified deposits. The postoperative course was uneventful without recurrence or severe complications except cataract. His corrected visual acuity was 20/40 one year after surgery. This case illustrates that therapeutic penetrating keratoplasty can be effective for fungal corneal ulcer that has failed to respond to medical treatments.