角膜腐食に対する角膜上皮形成術keratoepithelioplasty

Keratoepithelioplasty in chemical burn

　角膜上皮形成術keratoepithelioplasty単独，あるいは表層角膜移植との同時手術を施行した6例の化学腐食眼（受傷程度はGradeIIIと推定される症例）について，術後創傷治癒過程を細隙灯顕微鏡で詳細に観察した．術後角膜表面の上皮欠損は，lenticule上のdonor角膜上皮からの再生上皮により1〜2週間で修復された．上皮型拒絶反応は術後1〜8カ月の間に，様々な程度で6例全例に発生したが，ステロイドに良好に反応した．Donor角膜上皮がhost結膜上皮に拒絶反応とともに完全置換したものは1眼のみで，他の5眼ではdonor角膜上皮は島状に残存した．このdonor角膜上皮は，臨床的な拒絶反応を伴うことなく，host再生結膜上皮に徐々に置換した．完全な上皮置換例では，周辺部角膜に軽度の表層性血管新生を認めたが，角膜実質混濁の程度には変化を示さなかった．術後視力はhost結膜上皮に置換後も，術前と比較すると全例で改善傾向を維持し，表層角膜移植を併用した例では視力改善も著明であった．6眼中2眼が術後経過中に眼圧上昇を来したが，ステロイド局所投与の制限と緑内障治療薬により正常眼圧にコントロールされた．今回の結果から，keratoepithelioplastyは表層性血管新生を伴う結膜化した腐食角膜に対する有効な外科的治療方法と考えられた．

We performed keratoepithelioplasty in 6 eyes after the method originally developed by Thoft in 1984. All the treated eyes had suffered chemical injuries and were in cicatricial phase, with the ocular surface exhibiting total conjunctival epithelialization. Keratoepithelio-ulastv was uerformed either alone or combined with lamellar keratoplasty in our series.

Postoperatively, we could confirm that the regenerat-ed epithelium on the bared cornea was mainly of donor corneal origin from the lenticules. Epithelial rejection occurred in all the cases, 1 to 8 months after surgery.The severity was variable and all the cases responded favorably to topical corticosteroid treatment. Even after episodes of epithelial rejection, the donor corneal epithelium remained on the host cornea, for 1 to 16 months or more postoperatively. The ocular surface remained quiescent with minimal superficial vascular-ization, even after the donor corneal epithelium had been replaced by regenerated conjunctival epithelium of the host eye.

The postoperative visual acuity improved in all cases. Keratoepithelioplasty was effective in rebuilding healthy ocular surface after chemical injury in our series.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(1) : 21-26, 1987