タクロリムスが奏効した難治性Mooren潰瘍の1例

Tacrolimus ointment was effective in a protracted case of Mooren's ulcer

要約　目的：タクロリムスが奏効した難治性Mooren潰瘍の症例報告。症例：65歳男性。左眼痛で近医を受診し，周辺部角膜潰瘍と診断され，4か月後に紹介受診した。所見：結膜充血，輪部浮腫，周辺部下掘れ潰瘍を認めた。結膜切除術と角膜上皮形成術を施行し，術後，ベタメタゾン点眼，シクロスポリン点眼，プレドニゾロン内服を行うも病勢は抑えきれず，自家作製タクロリムス眼軟膏を追加し，増悪傾向が抑えられた。タクロリムス眼軟膏のコンプライアンスが悪く，角膜菲薄化，浸潤が増強したため，初回手術から2年後，結膜切除術と角膜上皮形成術を施行した。以後，タクロリムス点眼の併用で鎮静化している。結論：難治性のMooren潰瘍には，手術と薬剤治療の併用が必要で，タクロリムスはその選択肢の1つとなる。

Abstract.　Purpose：To report a protracted case of Mooren's ulcer treated by topical tacrolimus. Case：A 65-year-old male was referred to us for corneal ulcer since 4 months before. He had suffered from alkhali burn in the right eye 8 years before. Finding：Corrected visual acuity was no light perception right and 1.2 left. The left eye showed conjunctival injection, perilimbal edema, and peripheral corneal ulcer with undermining. The left eye was treated by conjunctival resection and keratoepithelioplasty followed by instillation of betamethasone and cyclosporine. He started receiving tacrolimus ointment 2 months later. Pain in the left eye persisted with corneal thinning and progression of corneal ulcer involving three quadrants. The left eye was treated again by conjunctival resection and keratoepithelioplasty with instillation of tacrolimus ophthalmic solution 2 years later. The corneal lesion subsided another 18 months later. Conclusion：Repeated surgery with instillation of tacrolimus was effective for protracted Mooren's ulcer in the present case.