治療的角膜移植に至った真菌性角膜炎4例の組織所見と臨床所見の対比

Clinical and pathological findings of four cases of mycotic keratitis treated by therapeutic keratoplasty

要約　目的：角膜移植を受けた真菌性角膜炎4例の臨床と病理所見の報告。症例：真菌性角膜炎4例4眼を対象とした。男女各2例で，年齢は52～86歳（平均74歳）である。全例に治療的角膜移植を行い，摘出した角膜片の病理所見と臨床所見とを対比した。結果：分離された菌は4例とも糸状菌で，Fusarium solani 2例，Beauveria bassiana 1例，菌種不明1例であった。臨床所見との対比で以下の所見があった。炎症が高度でも活動性の高い真菌が存在しないことがあった。角膜内に真菌がある場合には眼表面と前房側から炎症細胞が浸潤していた。角膜穿孔例では穿孔部を線維素性物質や炎症細胞が埋め，角膜厚と前房深度を維持していた。結論：真菌性角膜炎では，病理所見は必ずしも臨床所見を反映しない。

Abstract.　Purpose：To report clinical and pathological findings of 4 cases of fungal keratitis. Cases：The present study was made on 4 eyes of 4 cases of mycotic keratitis. The series comprised 2 males and 2 females. The age ranged from 52 to 86 years, average 74 years. The affected eyes received therapeutic keratoplasty. The removed specimens were examined histopathologically. Findings：All the 4 eyes showed filamentous fungi, comprising Fusarium solani 2 eyes, Beauveria bassiana one eye, and unclassified one eye. Severity of keratitis did not always match the activity of causative organism. When the fungi were present in the cornea, inflammatory cells invaded from the anterior and posterior corneal surface. After corneal perforation, the perforate site was filled by fibrotic material and inflammatory cells resulting in preservation of corneal thickness and the anterior chamber. Conclusion：Histopathological findings in fungal keratitis do not always reflect the clinical severity.