角膜内皮移植術を施行したDescemet膜下血腫の1例

A case of hematoma anterior to the Descemet membrane treated by endothelial keratoplasty

要約　目的：新生血管がある角膜に生じたDescemet膜下血腫に対し，角膜内皮移植術が奏効した1例の報告。症例：70歳女性が，2か月前に生じた左眼視力低下で受診した。幼少期に角膜実質炎に罹患した疑いがあり，10年前に白内障手術が両眼に行われた。糖尿病，高血圧症，狭心症，脂質異常，深部静脈血栓症の既往があった。1年前に狭心症に対するステント留置術が行われた。ワルファリン内服を開始し，その3日後に左眼視力が低下し，角膜後面の血腫と診断された。所見：矯正視力は右0.7，左0.01で，左眼の角膜後面に瞳孔領を覆う血腫があった。2か月後にDescemet膜を剝離し，Descemet膜下の血腫を除去し，直径8mmの角膜内皮片を移植した。角膜染血が減少し，左眼視力は3か月後に0.1，1年後に0.5に改善した。結論：Descemet膜下血腫に対し，Descemet膜と血腫を除去した後の角膜内皮移植術が奏効した。

Abstract.　Purpose：To report a case of hematoma anterior to the Descemet membrane treated by endothelial keratoplasty. Case：A 70-year-old female was referred to us for sudden visual impairment in her left eye that occurred 2 months before. She had reportedly stromal keratitis during infancy. She had received cataract surgery 10 years before. She had history of diabetes mellitus, systemic hypertension, angina pectoris, and thrombosis in deep veins in the legs. She had received insertion of stent for angina. She had started receiving warfarin, followed by sudden visual impairment in the left eye 3 days later. Findings：Corrected visual acuity was 0.7 right and 0.01 left. The left eye showed hematoma in the deep corneal layer. She was treated, another 2 months later, by stripping of Descemet membrane, removal of hematoma, and transplantation of corneal endothelial with diameter of 8 mm. After gradual absorption of blood staining of cornea. Visual acuity improved to 0.1 three months and to 0.5 one year after surgery. Conclusion：Transplantation of corneal endothelium was effective for hematoma anterior to the Descemet membrane.