角膜生検による病理検査が有用であった角膜真菌症の2例

Corneal biopsy is an effective aid in establishing diagnosis in two cases of keratomycosis

要約　目的：角膜生検による病理検査が有用であった角膜真菌症の2例を報告。症例1：58歳，男性。木の枝により右眼を受傷し3週間後，当科受診。塗抹検査で真菌を認め，抗真菌剤による点眼・内服治療を開始したが進行したため，角膜実質内注射を施行した。その際に角膜生検を行った。症例2：73歳，男性。右眼角膜移植後の角膜潰瘍と穿孔で当科へ紹介となった。保存角膜移植を行った際に，角膜生検を行った。結果：2例とも生検の病理検査で真菌を認めた。培養検査は，症例1ではFusarium属が検出されたが，症例2では陰性であった。結論：数mm大の小さな角膜組織で病理検査は可能であり，角膜生検は必要に応じて考慮すべき検査である。

Abstract.　Purpose：To report two cases of keratomycosis diagnosed by corneal biopsy. Cases：Case 1：A 58-year-old male in the right eye injured by a tree branch visited our hospital three weeks later. As corneal scraping disclosed fungi, anti-fungal therapy was started intravenously and with eye drops. However, his keratomycosis progressed and intrastromal injection of antifungal drug and corneal biopsy was performed at the same time. Case 2：A 73-year-old male with a diagnosis of corneal ulcer and perforation after keratoplasty in the right eye visited our hospital. Corneal biopsy was performed at the time of transplantation of preserved cornea. Results：Corneal biopsy of both two cases disclosed fungi. In culture of scrapings, Fusarium sp. was betected in case 1, whereas none of microorganism was detected in case 2. Conclusions：Corneal biopsy by using a small fragment of corneal tissue can be an effective aid for identifying the cause of infectious keratitis in selected cases.