Wegener肉芽腫症による強膜穿孔に対し自己大腿筋膜移植術を行った1例

A case of Wegener's granulomatosis with scleromalacia pertorans treated by fascia lata grafting

（R2-9AM−10）　49歳男性が両眼の強膜炎と右眼角膜潰瘍で受診した。4年前に膝が腫脹し，Wegener肉芽腫症と診断され，ステロイド薬と免疫抑制薬の治療を受けていた。初診から22か月後に左眼の鼻側強膜に軟化と穿孔，硝子体脱出が生じた。強膜穿孔部に自己大腿筋膜をただちに移植した。右眼の強膜軟化部にも1か月後に同様の移植術を行った。以後11か月間，両眼とも移植片の接着は良好であり，新たな炎症は生じていない。Wegener肉芽腫症に続発した重症の壊死性強膜炎による強膜穿孔に，自己大腿筋膜移植術が有効であることを示す症例である。

A 49-year-old male presented with scleritis in both eyes and corneal ulcer in the right. He has developed knee swelling leading to the diagnosis of Wegener's granulomatosis. He had been under treatment with systemic corticosteroid and immunosuppressive agents. He developed scleromalacia perforans with vitreous prolapse in the left eye 22 months after initially seen by us. The perforated sclera was immediately covered by autogenous fascia lata grafting. The right eye underwent similar treatment for scleromalacia one month later. The postoperative course has been uneventful without recurrence of inflammation during the follow up for 11 months. This case illustrates the effectiveness of autogenous fascia lata grafting for severe scleromalacia perforans secondary to Wegener's granulomatosis.