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56歳男性が3日前からの右眼の異物感で受診した。矯正視力は03であり,角膜潰瘍と虹彩炎があった。抗菌剤の点眼に反応せず病変が悪化し,2週後に前房蓄膿が生じた。角膜潰瘍擦過物の鏡検で糸状型真菌,培養でFusarium solaniが検出された。抗真菌剤の多剤併用で真菌症は治癒し,角膜の実質浅層に限局する混濁が残った。初診から6か月後にエキシマレーザーによるphototherapeutickeratectomy (PTK)を行い,その7か月後に1.0の矯正視力を得た。角膜真菌症治癒後の角膜混濁にPTKが奏効した症例である。
A 56-year-old male presented with foreign body sensation since 3 days before. His corrected visual acuity was 0.3. His left eye showed corneal ulcer and iritis. Treatment with topical antifungal agents was ineffective and was followed by hypopyon 2 weeks later. Fusarium solani was isolated from scrapings of the corneal ulcer.Treatment with fluconazole, miconazole and pimaricin induced clinical cure leaving opacity in the anterior corneal stroma. We treared the corneal opacity by phototherapeutic keratectomy (PTK) using an excimer laser 6 months after his initial visit. The visual acuity improved to 1.0 7 months later. This case illustrates that PTK may be effective for corneal opacity following keratomycosis.
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