長期緑内障点眼による皮膚癒着をきたした眼瞼外反症術後皮膚欠損に被覆材DuoActive® ETが奏効した1例

Efficacy of DuoActive® ET on postoperative skin defect with cicatricial ectropion following long-term topical treatment for glaucoma

要約　目的：長期緑内障点眼によって瞼縁皮膚癒着を合併した下眼瞼外反症の術後の皮膚欠損に，被覆材DuoActive^® ETを利用して治癒できた症例の報告。

症例：76歳，男性。近医より右下眼瞼外反症を指摘され，紹介受診となる。15年以上プロスタグランジン（PG）製剤点眼にて緑内障加療され，慢性眼瞼炎，流涙の既往があった。初診時に右下眼瞼外反，高度結膜充血，眼脂，眼瞼縁炎を認めた。外反した瞼縁と下眼瞼皮膚との癒着が強く，高度な皮膚発赤，菲薄化を認めた。眼瞼水平方向弛緩も強く，lateral tarsal strip procedure術を行い，外反した瞼縁を鈍的に分離した。術後に下眼瞼縁，外眼角部皮膚欠損を認めたため，皮膚再生を促すとともに再癒着防止のため被覆材DuoActive^® ETを使用した。被覆2週間後に外反矯正良好，創部上皮再生，創傷治癒した。

結論：PG製剤長期点眼による高度下眼瞼縁炎を合併した外反症は，瞼縁皮膚癒着が高度であり，通常の外反手術のみでは再癒着など増悪の可能性があり，術後皮膚欠損に対して被覆材DuoActive^® ETが創傷治癒に簡便で有用であった。

Abstract　Purpose：To report the efficacy of DuoActive^® ET on skin defect following lateral tarsal strip procedure（LTSP）for cicatricial ectropion in a case of long-term treatment with glaucoma eyedrop.

Case：A 76-year-old man was referred to us for cicatricial ectropion in the right lower eyelid.

Findings and Clinical Course：This patient presented with severe ectropion of his right lower eyelid with conjunctivitis, plenty of discharge and apparent dermodesis of the inflammatory lid margin and skin. He had been using prostaglandin eyedrop for glaucoma for more than 15 years. The horizontal looseness of his lower eyelid was prominent and the lateral tarsal strip procedure was performed. The dermodesis of lid margin and skin was separated. Skin defect was noted around his lateral canthus and lower eyelid right after the surgery. DuoActive^® ET was applied for wound healing. The skin healed in two weeks with good formation of lateral canthus and eyelid contour.

Conclusion：Prolonged application of prostaglandin eyedrop is a risk factor for cicatricial ectropion. DuoActive^® ET was simple and effective for would healing in skin defect following eyelid surgery.