残存水晶体核による水疱性角膜症の1例

A case of bullous keratopathy due to retained nuclear fragment after cataract surgery

要約　目的：白内障手術後に水晶体核が残存し，水疱性角膜症に至った症例の報告。

症例：74歳，男性。近医で左眼の白内障手術を受け，約7か月後に原因不明の視力低下で当科を紹介され初診となった。

所見：初診時左眼の視力は（0.7）で軽度の結膜充血があり，角膜は軽度の浮腫とDescemet膜の皺襞があった。角膜内皮細胞密度は307個/mm²であり，水疱性角膜症と診断した。隅角鏡で3時の隅角に異物を認め，初診から約2週間後に異物除去術を施行した。異物は層状構造で，成分分析で蛋白質であったため水晶体核と考えられた。

結論：白内障術後に残存水晶体核が長期に残存し，水疱性角膜症に至る症例があり，注意する必要がある。

Abstract　Purpose: To report a case of bullous keratopathy due to a piece of retained nuclear fragment after cataract surgery.

Case: A 74-year-old man was referred to us for impaired visual acuity in the left eye. He had received cataract surgery 7 months before.

Findings and Clinical Course: Best corrected left visual acuity was 0.7. The left eye showed mild conjunctival injection, mild corneal edema, and folds of Descemet membrane. Endothelial cell density was 307 cells/mm². The left eye was diagnosed with bullous keratopathy. Gonioscopy showed a foreign body at 3 o'clock position. It was surgically removed 2 weeks later. The removed foreign body proved to consist of protein, and was presumed to be a piece of nuclear fragment after cataract surgery.

Conclusion: This case illustrates that retained nuclear fragment after cataract surgery may induce bullous keratopathy.