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26歳男性が近視手術を希望して受診した。両眼とも約9Dの近視があり,矯正視力は1.2であった。右眼には−1.25D,左眼には−1.75Dの直乱視があったが、角膜形状解析装置を含む諸検査で不正乱視はなかった。右眼に対して,エキシマレーザーによる屈折矯正角膜切除photorefractive keratectomy(PRK)を行った。術後1か月で近視はほとんど消失したが,角膜上皮下混濁のために矯正視力は0.7であった。左眼には近視手術は行わなかった。右眼手術の21か月後に,左眼に急速に進行する近視と,耳側に偏った強い不正乱視が生じ,円錐角膜と診断した。本症例は,円錐角膜が20歳台の後半に発症しうることと,屈折矯正手術の適応の決定に注意が必要であることを示している。
A 26-year-old male presented with myopia. Both eyes showed myopia of about -9 diopters with corrected visual acuity of 1.2. Regular astigmatism of -1.25 D and -1.75 D was present in the right and left eye respectively. Detailed examinations including the use of corneal topography ruled out irregular astigmatism. His right eye was treated by excimer laser photorefractive keratectomy (PRK) . The treated eye became almost emmetropic one month after surgery. The visual acuity was reduced to 0.7 due to subepithelial corneal haze. The left eye, which was put under observation without surgery, developed rapidly progressive myopia with irregular astigmatism in the temporal cornea 21 months later, leading to the diagnosis of keratoconus. This case illustrates that keratoconus may become manifest after 20 years of age and that due attention is necessary in the selection of candidate for refractive surgery.
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