翼状片手術後に強膜膿瘍をきたした慢性腎不全患者の1例

Scleral abscess after surgery for pterygium in a patient with chronic renal failure

要約　目的：翼状片の手術後に強膜膿瘍が生じた慢性腎不全患者の報告。症例：20年前から高血圧，痛風，腎不全があり，1年前から透析を受けている71歳男性が，左眼の翼状片手術を受けた。遊離結膜弁移植が行われ，弁は上方の輪部付近から採取され，その部位のテノン囊は露出したままであった。5週間後に眼痛と充血が生じ，結膜弁の採取部位に強膜膿瘍があった。複数の抗生物質とステロイド剤の点眼は無効で，その4週間後に当科を受診した。強膜中層に及ぶ膿瘍があり，薬物が奏効しなかったため，膿瘍を切除した。抗生物質の点眼のみで術後の経過は良好であり，膿瘍の再発はなかった。結論：薬物療法に抵抗する強膜膿瘍には，排膿と切除が有効である。

Abstract.　Purpose：To report a case with chronic renal failure who developed scleral abscess after pterygium surgery. Case：A 71-year-old male received surgery for pterygium in his left eye. He had been diagnosed with systemic hypertension, gout, and renal failure 20 years before. He had been receiving hemodialysis since one year before. After resection of pterygium, the conjunctival defect was covered by free conjunctival flap. The flap was obtained from site superior to the limbus in the same eye. This tenon capsule in this site was left bare. Five weeks after surgery, the left eye developed hyperemia and pain due to scleral abscess from the site where the flap was obtained. The abscess failed to respond to topical corticosteroid and antibiotics. The patient was referred to us another 4 weeks later. The abscess reached the middle scleral layer and had to be resected. Cure was obtained by topical antibiotics only. Conclusion：Drainage and resection may be effective for scleral abscess that does not respond to medical treatments.