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要約 目的:移植した羊膜に生じた広範囲のカルシウム沈着に対して強角膜移植を行った症例の報告。症例:71歳女性が左眼の視力低下で受診した。43年前にStevens-Johnson症候群と診断され,18年前に左眼に全層角膜移植術を受けた。所見:矯正視力は右手動弁,左0.01で,両眼に瘢痕性角結膜上皮症があり,右眼の状態がより重篤であった。左眼に移植された角膜には浮腫混濁があり,移植片機能不全であった。経過:左眼に全層角膜移植術,羊膜移植術,下方に輪部移植術を行った。15か月後に移植した羊膜片にカルシウムが沈着した。その4か月後に直径18mmの強角膜片を全層移植した。術後6か月間は0.1の視力を維持したが,最終的に水疱性角膜症になった。結論:眼球表面への羊膜移植ではカルシウム沈着がありうる。これが広範囲にあるときには,強角膜移植が選択肢の1つになる。
Abstract. Purpose:To report a case who received corneoscleral transplantation for amniotic membrane that showed extensive calcification. Case:A 71-year-old female presented with impaired visual acuity in both eyes. She had been diagnosed with Stevens-Johnson syndrome 43 years before. She had received penetrating keratoplasty 18 years before. Findings:Corrected visual acuity was hand motion right and 0.01 left. Both eyes showed cicatricial keratopathy. The right eye was more severely affected. Clinical Course:The left eye underwent penetrating keratoplasty,transplantation of amniotic membrane,and limbal transplantation in the inferior sector. Extensive calcification developed on the amniotic membrane 15 months later and was covered by whole corneoscleral grafting. Visual acuity improved to 0.1 for 6 months but deteriorated due to bullous keratopathy. Conclusion:The present case illustrates that amniotic membrane may undergo calcification after transplantation to the eye. Whole-layer corneoscleral grafting may be effective in such a condition.
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