Werner症候群における白内障術後の合併症と角膜障害

Complications and keratopathy following cataract surgery in a case with Werner's syndrome

　Werner症候群における角膜変性には角膜内皮障害が重要な因子として関与している．今回，白内障術後1年にて1眼に続発性緑内障から水疱性角膜炎，角膜潰瘍，眼内炎を発症して36カ月後に眼球摘出にいたったWerner症候群の症例を経験した．他眼には創口治癒遅延による濾過瘢痕が生じており，角膜内皮細胞は著明な減少を示していた．角膜内皮細胞減少と糖尿病の合併による易感染性，角膜上皮細胞やkeratocyteの機能不全などが角膜障害に関係していると思われる．したがって本症候群の白内障術前後には角膜内皮撮影によって角膜内皮の状態を注意深く調べ，術式もできるだけ侵襲の少ないものを選ぶとともに術後，長期にわたる経過観察が望ましい．

A 53-year-old female was presented with typical features of Werner's syndrome with shortness of statuture, poliosis, alopecia, atrophic skin, calcification of soft tissues, diabetes mellitus, osteoporosis and juve-nile cataract. One year after uneventful extracapsular lens extraction in both eyes, bullous keratopathy and glaucoma developed in the left eye. The bullous ker-atopathy persisted after control of glaucoma by medica-tion. Subsequent corneal ulcer and endophthalmitis necessitated enucleation of the left eye. The right eye showed a pronounced reduction in the number of corneal endothelial cells of 1,040/mm² 14 years after cataract surgery.The presence of diabetes mellitus, disorders in the immune system and impaired surgical wound repair through incompetence of epithelial cells and kera-tocytes in this syndrome seemed to have acted as under-lying or contributing factors for the severe corneal lesions following cataract surgery.