TS-1®使用患者の白内障手術後に急激な異常上皮の角膜進入をきたした1例

Rapid epithelial invasion into the cornea after cataract surgery in a patient under treatment with TS-1®

要約　背景：TS-1^®は，テガフール，ギメラシル，オテラシルを含む複合薬で，悪性腫瘍に対して経口投与される。目的：TS-1^®を服用中の患者に白内障手術を行い，異常上皮が角膜に進入した1症例の報告。症例：70歳の女性が視力障害で受診した。6年前に胆管癌の手術を受け，TS-1^®の2週服薬と2週休薬を繰り返していた。所見と経過：矯正視力は右0.8，左0.08で，両眼に白内障があった。白内障手術をまず右眼に，1か月後に左眼に行った。上方の結膜を4.5mm切開し，3mmの強角膜切開で手術を行った。視力は右1.2，左0.3に回復した。4か月後に流涙と視力障害が生じ，視力が0.5と0.1に低下した。上方の結膜切開部から角膜中央部まで境界明瞭な異常上皮の進入と血管新生があり，上下の涙小管が閉塞していた。TS-1^®による角結膜上皮障害と診断した。人工涙液の頻回点眼を行い，異常上皮は右眼では2か月後，左眼では6か月後に異常上皮の境界線が後退した。通院はその後中断した。結論：白内障手術での上方強角膜切開により輪部構造が障害され，TS-1^®の服用が異常上皮進入を助長したと推定される。

Abstract.　Background：TS-1^® is a complex preparation containing tegafur, gimeracil and oteracil. It is used for malignancies. Purpose：To report a case who showed rapid epithelial invasion into the cornea after cataract surgery while under treatment with TS-1^®. Case：A 70-year-old female presented with impaired visual acuity. She had received surgery for hepatic cholangiocarcinoma 6 years before and had since been receiving TS-1^® following the regimen of 2 weeks of intake with 2 weeks of discontinuation for 2 weeks. Findings and Clinical Course：Corrected visual acuity was 0.8 right and 0.08 left. Both eyes showed cataract. Cataract surgery was performed by dissection of upper conjunctiva by 4.5 mm and by sclerocorneal incision by 3 mm in the right eye. The left eye received a similar procedure one month later. Visual acuity improved to 1.2 right and 0.3 left. The patient developed lacrimation 4 months later, with visual acuity down to 0.5 right and 0.1 left. Both eyes showed epithelial invasion in the upper sector extending to the corneal apex, with occlusion of upper and lower lacrimal puncta. The findings appeared to be due to intake of TS-1^®. Frequent instillation of artificial tears was followed by regression of abnormal epithelium 2 months later in the right cornea and 6 months later in the left. Conclusion：Destruction of corneal limbus by cataract surgery incision may have resulted in abnormal epithelial invasion into the cornea. Systemic treatment with TS-1^® appears to have furthered this process.