非ステロイド系抗炎症剤点眼による角膜移植後の遷延性上皮欠損

Persistent corneal epithelial defects following keratoplasty and instillation of nonsteroidal anti-inflammatory agent

　全層角膜移植後に非ステロイド系抗炎症剤点眼（0.1％ジクロフェナクナトリウム）投与を併用して，遷延性角膜上皮欠損を生じた5例を報告した。これらの症例では，術前に何ら上皮障害の危険因子はなく，ジクロフェナク点眼の関与が強く疑われた。全症例において，眼帯，治療用コンタクトレンズ装用，ヒアルロン酸点眼によって術後15〜34日で上皮化された。角膜移植後など，角膜上皮が不安定な状態にあるときの非ステロイド系抗炎症剤点眼は，慎重に行われるべきと考えられた。

Five eyes manifested persistent corneal epithelial defects for 2 weeks or longer after penetrating keratoplasty. All the eyes had been under treatment with 0.1% sodium diclofenac ophthalmic solution, a nonsteroidal anti-inflammatory agent. None of these cases showed abnormal epithelium of the cornea or the conjunctiva preoperatively, strongly suggesting the association of eyedrops and persistent epithelial defects. The defects were epithelialized in 15 to 34 days after treatment with patching, bandage soft contact lens wear or instillation of hyaluronic acid ophthalmic solution. The use of sodium diclofenac solution is to be discouraged to patients with susceptible corneal epithelium including postkeratoplasty period.