眼球摘出に至ったアカントアメーバ角膜炎

A case of Acanthamoeba keratitis with eventual enucleation

要約　目的：眼球摘出に至ったアカントアメーバ角膜炎の症例の報告。症例：58歳女性が右眼の視力低下と眼痛で受診した。ワンデー用のソフトコンタクトレンズを数日連続装用していた。2か月前に右眼痛があり，角膜ヘルペスと診断され，副腎皮質ステロイド点眼を含む治療を受けていた。加療中に前房蓄膿が生じた。所見：矯正視力は右手動弁，左1.0で，右眼の角膜全面に，前房蓄膿を伴う潰瘍と浸潤があった。角膜実質の鏡検と培養でアカントアメーバが検出された。ステロイド薬の点眼を中止し，複数の点眼と全身投与を行った。3週間後に角膜が穿孔し，保存角膜を移植した。輪部角膜が融解し，初診から50日後に眼球を摘出した。結論：進行したアカントアメーバ角膜炎は，すべての治療に抵抗することがある。

Abstract.　Purpose：To report a case of Acanthamoeba keratitis that resisted treatment and resulted in enucleation. Case：A 58-year-old female was referred to us for pain and impaired vision in the right eye. She was a habitual user of day-war contact lens and had the habit to wear the same contact lens for several days before changing. She developed pain in the right eye 2 months before. She was diagnosed with herpetic keratitis and was treated by eyedrops including corticosteroid. Findings：Corrected visual acuity was light perception right and 1.0 left. The right eye showed corneal ulcer involving the whole surface and hypopyon. Acanthamoeba was found by biopsy and culture of the corneal stroma. She was treated by topical and systemic antifungal agents. The right cornea perforated 3 weeks later and received transplantation of preserved cornea. The limbal cornea melted another 30 days later necessitating enucleation. Conclusion：This case illustrates that advanced corneal Acanthamoeba may fail to respond to all therapeutic attempts.