翼状片手術後の強膜穿孔に保存角膜移植が奏効した1例

Transplantation of preserved cornea was effective for scleral perforation in a case after pterygium surgery

要約　目的：翼状片への手術から18年後に発症した強膜穿孔に保存角膜移植が奏効した症例の報告。症例：77歳男性が18年前に右眼翼状片手術を受けた。右眼に霧視が生じ，強膜軟化症と眼内炎があり，紹介され受診した。8年前に右眼に白内障手術を受けた。所見と経過：矯正視力は右0.02，左1.2であった。右眼の鼻側強膜が菲薄化し，硝子体混濁と脈絡膜剝離があった。経過中に強膜が穿孔し，低眼圧になった。－20℃で保存してあった角膜片で穿孔部を被覆し，脈絡膜剝離，硝子体混濁，低眼圧は消失し，移植部は結膜の上皮化が得られた。術後1年目の視力は右0.06，左1.2であった。結論：強膜軟化症による強膜穿孔に対し，移植保存角膜が生着し，視機能が保存できた。

Abstract.　Purpose：To report a case of scleral perforation secondary to late-onset scleromalacia treated by transplantation of preserved cornea. Case：A 77-year-old male was referred for scleromalacia and endophthalmitis in the right eye. His right eye had received surgery for pterygium 18 years before and for cataract 8 years before. Findings and Clinical Course：His corrected visual acuity was 0.02 right and 1.2 left. The right eye showed attenuation of sclera in the nasal sector,vitreous opacity and choroidal detachment. The sclera perforated during treatment. A piece of cornea preserved at －20℃ was sutured to the perforated site. The treatment was followed by disappearance of choroidal detachment,vitreous opacity,and ocular hypotony. The scleral lesion was covered by conjunctival epithelium. The right eye regained visual acuity of 0.06 one year after treatment. Conclusion：Transplantation of preserved cornea was effective for scleral perforation secondary to late-onset scleromalacia.