アトピー性皮膚炎を合併した角膜移植症例の検討

Review of keratoplasty in patients with atopic dermatitis

要約　目的：アトピー性皮膚炎がある症例に対する角膜移植の，拒絶反応，感染，アトピー性強角膜炎を含めた術後経過の報告。対象と方法：2014年までの9年間に行った初回角膜移植189例のうち，アトピー性皮膚炎がある9例9眼を対象とし，診療録の記述をもとに検討した。男性6例，女性3例で，平均年齢は44歳であった。角膜移植が行われた原因疾患は，水疱性角膜症2眼，円錐角膜5眼，角膜穿孔1眼，角膜ジストロフィ1眼で，7眼に全層角膜移植，2眼に表層角膜移植が行われた。結果：術後28か月の間に，拒絶反応が4眼（57％）に生じ，1眼に再移植が行われた。2眼に術後感染があり，角膜または前房水からメチシリン耐性黄色ブドウ球菌（MRSA）が検出された。角膜移植後のアトピー性強角膜炎はなかった。結論：アトピー性皮膚炎がある症例に対する角膜移植では，拒絶反応の予防とMRSAなどによる感染症に留意する必要がある。

Abstract.　Purpose：To report the outcome of keratoplasty in cases with atopic dermatitis with particular attention to graft rejection, infection, and atopic sclerokeratitis. Cases and Method：A total of 189 keratoplasty had been performed during 9 years through 2014 by us. Out of this series, we made a retrospective study on 9 eyes of 9 patients with atopic dermatitis. There were 6 males and 3 females. The age averaged 44 years. Keratoplasty was performed for bullous keratopathy 2 eyes, keratoconus 5 eyes, corneal perforation one eye, and corneal dystrophy one eye. Perforating keratoplasty was performed on 7 eyes and lamellar keratoplasty on 2 eyes. Results：Four eyes（57％）developed graft rejection during the period of observation averaging 28 months. One eye received another session of keratoplasty. Two eyes developed infection after surgery. Methicillin-resistant Staphylococcus aureus was cultured from the cornea or anterior chamber in these 2 eyes. There was no case of atopic sclerokeratitids after keratoplasty. Conclusion：These cases illustrate the need to prevent graft rejection and infection by MRSA after keratoplasty in cases with atopic dermatitis.