特異な経過を示したContact lens corneaの1例

Marginal keratopathy simulating contact lens cornea in a case with rheumatoid arthritis

　69歳男性の両眼に発症したcontact lenscorneaの一例を報告した．

　本例は難治性の結膜炎として発症し，次第に上強膜炎および強膜炎の症状が出現し，炎症症状の悪化に従って輪部結膜が角膜周辺部へ侵入するとともに，周辺部角膜が連続性に菲薄化する特異な病変を示した．経過中に慢性関節リウマチおよびシェーグレン症候群が確認されたことから，Con-tact lens corneaと診断した．

　保存的療法とステロイド療法を併用したが再発を繰り返したため，cyclophosphamideの投与を行ったところ症状は劇的に改善した．

　本症の難治例に対してはcyclophosphamideの投与が有効であると考えられた．

A 69-year-old nian presented with peculiar marginal keratopathy simulating 'contact lens cornea' bilateral-ly. A definitive diagnosis of Sjcbgren syndrome with rheumatoid arthritis was made later. The initial sign was severe bilateral scleritis associated with sickle shaped thinning of the peripheral cornea. The thickness of the affected cornea was about one-third of the intact area. The lesion was well demarcated by a central edge. Newly formed vessels invaded into the lesion from the perilimbal conjunctiva. The keratopathy progressed following topical and systemic corticosteroid treatmentand resulted in perforation of the cornea in the right eye. Biopsy of the retrobulbar mass led to the diagnosis of non specific inflammatory pseudotumor of the orbit. The lesions subsided without remission after systemic treatment with cyclophosphamide. The finding illus-trates that immunosuppressive therapy is a treatment of choice in such a case of collagen disease involving the cornea associated with orbital lesions and rheumatoid arthritis.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(1) : 41--45, 1980.