手術創の角膜実質層間に発症した角膜感染症の1例

A case of lamellar keratitis adjacent to previous corneal surgical wound

要約　目的：白内障手術後に生じた角膜実質層間感染症の症例の報告。症例：81歳男性が右眼の眼痛と充血で受診した。1年前から点状表層角膜症があり，フルオロメトロンを点眼していた。7年前に水晶体乳化吸引術と眼内レンズ挿入術を，3年前に線維柱帯切除術を右眼に受けた。所見：右眼視力は0.4で，白内障手術の強角膜創に一致して羽毛状の角膜浸潤と血管侵入があった。抗菌薬と抗真菌薬に反応せず，7週間後に前房蓄膿を伴う眼内炎が生じた。硝子体手術を行い，眼内レンズを摘出し，角膜層間を洗浄した。前房水，眼内レンズ，硝子体の培養検査は陰性であった。術後に病変は消退し，0.8の最終視力を得た。結論：本症例では病巣が白内障の手術創と一致し，層間に感染が広がったと推定される。層間の角膜感染症は，保存的治療が奏効しないときには外科的治療が選択肢の1つになる。

Abstract.　Purpose：To report a case of lamellar keratitis following cataract surgery. Case：A 81-year-old male presented with pain and hyperemia in his right eye. He had been treated with fluorometholone for superficial punctuate keratopathy since one year before. The right eye had received cataract surgery 7 years before and trabeculectomy 3 years before. Findings：Corrected visual acuity was 0.4. The right cornea showed lamellar infiltration with neovascularization adjacent to the wound of previous cataract surgery. Topical and systemic antibiotics and antifungal drugs were followed by endophthalmitis with hypopyon 7 weeks later. Cure was obtained after vitrectomy, removal of intraocular lens, and lamellar irrigation. Culture of intraocular fluid, intraocular lens and vitreous were negative. Conclusion：Site of corneal infiltration corresponded with the wound of cataract surgery in this patient. Surgical treatment may be indicated when medication proves futile in corneal lamellar infection.