角結膜腐蝕に対する角膜移植

Keratoplasty for thermal and chemical burn

　角結膜腐蝕の17眼に全層角膜移植を，1眼に表層角膜移植を施行し，移植片の長期予後を観察した．術前に結膜上皮（上皮下組織を含む）の角膜内侵入が軽微であった7眼の移植片では，術後上皮欠損が2眼に発生したが，5眼（72％）が7年以上透明性を維持した．一方，術前に結膜上皮が角膜内に侵入被覆していた11眼では，全例に術後上皮欠損が発生し1年以内に移植片は混濁した．この結果，結膜上皮が全周から角膜内に侵入被覆した角結膜腐蝕眼に対する全層角膜移植は禁忌であると考えられた．

We evaluated the long-term outcome of kerato-plasty for thermally or chemically injured cornea. This study included 17 eyes treated by penetrating keratoplasty and one eye by lamellar keratoplasty. We divided the cases into two major categories regarding the ocular surface manifestations. Cases with corneal scarring with minimal conjunctival invasion into the cornea were assigned to Type A. Those with corneas completely covered by invaded conjunctiva were assigned to Type B or C. Eyes in Type C underwent conjunctival transplantation prior to keratoplasty.

The cornea graft remained transparent in 5 out of 7 eyes in Type A, for as long as 7 years. In all of 11 eyes in Type B and C, epithelial defects devel-oped after keratoplasty and resulted in failed grafts within one year. The finding suggests that conven-tional keratoplasty is to be avoided, for the time being, in corneal burn with complete invasion of the conjunctiva.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(11) : 1287-1290, 1988