角膜真菌症の早期診断・早期治療

Early diagnosis and treatment of keratomycosis

　過去6年間に，当科ならびに関連病院で角膜真菌症と診断された19例について検討した．その結果，（1）8例（42.1％）に角膜外傷の既往がはっきりしていた．内7例は植物による外傷であり，角膜真菌症の発症と植物による外傷に深い関係がみられた．（2）治療に用いたピマリシンは，18例中の17例に著効もしくは有効（累積有効率94.4％）であった．（3）潰瘍が汚く灰白色を呈し，その辺縁が不規則な症例やhyphate ulcerを見れば角膜真菌症を疑い，真菌の検出を行うとともにピマリシンによる早期治療を開始すべきである．これらのことが判明した．

To facilitate early diagnosis and initiate due specific treatment, we evaluated a consecutive series of 19 cases of clinically diagnosed keratomycosis. The corneal ulcer assumed a dirty color in all the cases. The ulcers were characterized by irregular edges in 14 eyes (74%) and appeared as hyphate ulcers in 8 (42%). The diagno-sis of keratomycosis was supported by laboratory find-ings in 17 eyes (90%). The keratomycosis was apparent-ly induced by corneal trauma in 8 eyes (42%), of which 7 were related to trauma of vegetative nature. The corneal lesion responded well to topical pimaricin ther-apy in 17 out of 18 instances (94%).

Keratomycosis should be suspected in the presence of corneal ulcers with above characteristics. Treatment with topical pimaricin is to be promptly started along with an attempt to identify the causative fungus by culture.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(4) : 325-329, 1986