久留米大学病院における真菌性角膜炎の検討

Review of keratomycosis at Kurume University Hospital

要約　目的：久留米大学病院で過去9年間に経験した真菌性角膜炎の報告。対象と方法：2010年までの9年間に診断治療した真菌性角膜炎30例30眼を対象とした。男性14例，女性16例で，年齢は32～87歳，平均65歳である。診断は角膜病巣部の検鏡または分離培養で行った。結果：検出菌は糸状菌21例，酵母菌9眼であった。全例に角膜擦過を行い，16例はこれに加えた抗真菌薬の局所および全身投与で治癒し，14眼では結膜被覆術や表層角膜移植術などの追加手術で治癒した。最終視力は手術を必要とした症例で不良であった。22例で糖尿病または受診前にステロイド点眼による治療があり，うち13例（59％）が手術を必要とした。結論：糖尿病またはステロイド使用による免疫低下状態があると，真菌性角膜炎の予後が不良になる。

Abstract.　Purpose：To present a review of ketatomycosis at Kurume University Hospital. Cases and Methods：This study was made on 30 eyes of 30 cases seen by us during 9 years through 2010. The series comprised 14 males and 16 females. The age ranged from 32 to 87 years, average 65 years. Diagnosis was made by microscopy or culture of scraped corneal lesion. Results：Keratomycosis was due to filamentous fungi in 21 cases and yeast in 9 cases. All the cases were treated by corneal debridement. Cure was obtained by topical and systemic antifungal agent in 16 cases. Fourteen cases received surgery including conjunctival transplantation or lamellar keratoplasty. Visual outcome was poor in cases needing surgery. Out of 22 cases with diabetes mellitus or had received topical corticosteroid, surgery had to be performed in 13 cases（59％）. Conclusion：Outcome of keratomycosis was poor in immunocompromised cases due to diabetes or prior corticosteroid therapy.