周辺部角膜潰瘍と結膜膿瘍を合併した白内障術後アスペルギルス角膜真菌症の1例

A case of keratomycosis with marginal corneal ulcer and conjunctival abscess following cataract surgery

要約　目的：白内障術後に周辺部角膜潰瘍と結膜膿瘍を合併した角膜真菌症の1例を報告する。症例：85歳男性，右眼の異物感と視力低下で受診した。1か月前に白内障手術を受け，10日前の農作業中，稲穂で右眼をついたとのことであった。所見：初診時右眼矯正視力は0.4であり，前房内に炎症所見を認めた。角膜耳下側周辺に感染によると思われる実質混濁とびらんを認めた。抗菌点眼薬を開始したが効果なく, 入院5日目に抗真菌治療に変更した。12日目には周辺部角膜の菲薄化とその部位に接する結膜の隆起性病変を生じた。35日目にBrown手術と感染巣の生検を施行したところ, 角膜実質内に多数の真菌を認め, 培養にてアスペルギルスを検出した。結膜隆起部は膿瘍であった。5回の表層角膜切除を追加し，137日目に感染の沈静化に至った。1年後現在まで再発はなし。結論：外傷後の角膜真菌症に周辺部角膜潰瘍を併発し難治であったが, 外科的治療が有用であった。

Abstract.　Purpose：To report a case of keratomycosis with marginal corneal ulcer and conjunctival abscess following cataract surgery. Case：An 85-year-old male presented with foreign body sensation and impaired vision in the right eye. He had received cataract surgery one month before and was hit by the ear of rice plant 10 days before. Findings：Corrected visual acuity was 0.4. The right eye showed signs of inflammation in the anterior chamber. The cornea showed opacity and erosion in the lower temporal sector, suggesting bacterial infection. Topical treatment with antibiotics was ineffective and was switched to antifungal drugs 5 days later. The cornea showed thinning and swelling in the adjacent conjunctiva on day 12. Brown surgery with biopsy was performed on day 35. The corneal stroma was filled with fungi that proved to be Aspergillus spp. by culture. The swelling of conjunctiva found to be due to abscess formation. The right eye healed after 5 sessions of keratotomy after 137 days. There has been no recurrence for one year until present. Conclusion：Surgical intervention was effective in the present case of intractable keratomycosis following cataract surgery and corneal trauma.