シクロスポリン内服により進行緩徐となったMooren潰瘍の1例

A case of inactivated Mooren ulcer following peroral cyclosporine

要約　目的：シクロスポリン内服が奏効した難治性Mooren潰瘍の症例の報告。

症例：71歳の男性が1か月前からの右眼角膜潰瘍で紹介受診した。糖尿病と直腸癌の既往があった。

所見と経過：矯正視力は左右眼とも1.2で、右眼の上半部の角膜辺縁に潰瘍があった。Mooren潰瘍と診断し、ステロイド剤の内服と点眼、タクロリムスの点眼などを行った。1週後に角膜が穿孔し、表層角膜移植が行われた。5か月後に潰瘍が再発し、強角膜移植を行った。その10週後に角膜潰瘍が全周性になり、強角膜移植を行った。それまでの点眼に加え、シクロスポリン内服を開始した。潰瘍の活動性は沈静化し、以後12か月後の現在まで再発はない。

結論：複数回の角膜移植と薬物治療に抵抗した難治性Mooren潰瘍に対し、シクロスポリン内服が奏効した。

Abstract　Purpose: To report a case of intractable Mooren ulcer that responded to systemic cyclosporine.

Case: A71-year-old male was referred to us for corneal ulcer in the right eye since one month before. He had history of diabetes mellitus and rectal carcinoma.

Findings and Clinical Course: Corrected visual acuity was 1.2 in either eye. The right cornea showed marginal ulcer in the upper hemisphere. He was diagnosed with Mooren ulcer, and was treated by topical tacrolimus as well as topical and systemic corticosteroid. The cornea perforated one week later and was treated by lamellar keratoplasty. Corneal ulcer recurred 5 months later and was treated by sclerokeratoplasty. Corneal ulcer extended to the whole corneal circumference and was treated by another sclerokeratoplasty. The patient started receiving peroral cyclosporine as additional treatment. Corneal ulcer became inactive with no recurrence for 12 months until present.

Conclusion: Systemic cyclosporine was effective for Mooren ulcer that recurred in spite of medical and surgical treatments.