毛様体光凝固術後にMooren潰瘍を発症し，角膜穿孔・眼球破裂に至った1例

A case of Mooren ulcer with corneal perforation following cyclophotocoagulation for glaucoma

要約　目的：毛様体光凝固後にMooren潰瘍が発症し，角膜穿孔と眼球破裂が生じた症例の報告。症例：64歳女性の右眼圧が上昇した。16年前に右眼に白内障と緑内障手術を受け，4年前から当科に通院中であった。所見：矯正視力は右0.7，左0.05であった。右眼は眼内レンズ挿入眼で，右眼は－9.0D，左眼は－18.0Dの近視であった。両眼とも開放隅角で，右眼圧は40mmHgであった。手術が拒否され，右眼に経強膜的に毛様体光凝固を行った。その直後から毛様充血が生じた。1か月後に角膜の耳側下方にびらんが生じ，3か月後に角膜が菲薄化した。ヘルペス感染と膠原病は否定され，Mooren潰瘍と診断した。毛様体光凝固の8か月後に角膜穿孔が突発し，眼球が虚脱した。角膜移植は拒否され，眼球内容除去術を行った。結論：経強膜毛様体光凝固には重篤な合併症として角膜障害が生じる可能性がある。

Abstract.　Purpose：To report a case who developed Mooren ulcer following cyclophotocoagulation resulting in corneal perforation. Case：A 64-year-old female developed elevation of intraocular pressure（IOP）. She had received surgery for cataract and glaucoma 16 years before. She had been treated by us since 4 years before. Findings：Corrected visual acuity was 0.7 right and 0.05 left. The right eye was pseudophakic. Myopia of －9.0D was present in the right eye and －18.0D in the left. Both eyes showed wide chamber angle. The right eye showed IOP of 40 mmHg. She refused surgery and the right eye was treated by transscleral cyclophotocoagulation. The right cornea showed erosion one month later and thinning 3 months later. The right eye was diagnosed with Mooren ulcer after exclusion of viral infection and collagen disease. The right cornea showed spontaneous perforation with collapse of the eyeglobe 8 months later. She refused keratoplasty and was treated by exenteration. Conclusion：This case illustrates that transscleral cyclophotocoagulation may be followed by corneal ulcer as a major complication.