眼窩減圧術後の全層角膜移植術により視力が回復した悪性眼球突出症の1例

Improved visual acuity following orbital decompression and penetrating keratoplasty in a case of malignant ophthalmopathy

　53歳女性が半年前に両眼の眼痛と視力低下で受診した。6か月前にGraves病を発症し，内科で加療中であった。矯正視力は右0.05，左0.08であり，両眼に眼球突出があり，閉瞼不能で兎眼性角膜潰瘍があった。眼窩減圧術とMüller筋延長術を行い，8か月後に右0.4，左0.03の矯正視力を得た。左眼の角膜混濁に対して全層角膜移植術と白内障手術を行い，0.5の矯正視力を得た。兎眼性角膜潰瘍を伴う悪性眼球突出症に対して，2段階での眼窩減圧術と全層角膜移植術が奏効した例である。

A 53-year-old female presented with bilateral ocular pain and blurred vision. She had been under systemic treatment for Graves' disease since 6 months before. Her corrected visual acuity was 0.05 right and 0.08 left. Both eyes showed malignant exophthalmos, inability of lid closure and lagophthalmic corneal ulcer. Both eyes underwent orbital decompression surgery and extension of Müller muscles, resulting in visual acuity of 0.4 right and 0.03 left 8 months later. The left eye was treated by penetrating keratoplasty and cataract surgery for corneal opacity, resulting in visual acuity of 0.5. This case illustrates that malignant exophthalmos with lagophthalmic corneal ulcer may be effectively treated by orbital decompression followed by penetrating keratoplasty.