細菌性角膜炎に対する深層層状角膜移植後に生じたヘルペス性角膜内皮炎の1例

Herpetic corneal endotheliitis in a case after deep lamellar keratoplasty for bacterial keratitis

要約　目的：深層層状角膜移植術後にヘルペス性角膜内皮炎が発症した症例の報告。症例：58歳男性が右眼の眼痛，充血，視力低下で受診した。2年前に右眼の感染性角膜炎に対し深層層状角膜移植，1年前に白内障手術を受け，矯正視力は0.8であった。所見：矯正視力は右0.07で，Descemet膜の皺襞と角膜後面沈着物があり，内皮型拒絶反応が疑われた。前房水をPCR法で処理し，水痘・帯状疱疹ウイルスが検出された。抗ウイルス薬で改善せず，プレドニゾロン点眼を増量した。病像は軽快し，5か月後に0.7の視力を得た。結論：角膜移植後に発症するヘルペス性角膜内皮炎は拒絶反応に類似し，診断が困難である。本症例では早期に診断が確定し，抗ウイルス薬とステロイド内服が奏効した。

Abstract.　Purpose：To report a case who developed herpetic corneal endotheliitis following deep lamellar keratoplasty for bacterial keratitis. Case：A 58-year-old male presented with hyperemia,ocular pain and impaired visual acuity in the right eye. He had received deep lamellar keratoplasty for bacterial keratitis 14 months before and cataract surgery 6 months before. He had visual acuity of 0.8. Findings：His corrected visual acuity was 0.07 right. The right eye showed folds of descemet membrane with keratic precipitates. The findings were suggestive of graft rejection. The aqueous humor was positive for herpes zoster virus after processing by PCR. Antiviral treatment failed to improve the clinical findings. He was then treated with systemic antiviral agents and prednisolone. The corneal lesion improved and resulted in visual acuity of 0.7 five months later. Conclusion：This case illustrates that herpetic corneal endotheliitis may simulate graft rejection and pose diagnostic difficulties in an eye with a history of keratoplasty. The present case resulted in fair outcome after prompt diagnosis followed by systemic treatment with antiviral agents and corticosteroid.