骨髄移植後の眼合併症とその治療

Ocular symptoms and treatments of graft-versus-host disease

　同種骨髄移植後におこる慢性移植片対宿主病として重症の眼症状を呈した6症例の経過とその治療を述べた。症状は涙液分泌減少によるもので，難治の点状表層角膜炎とそれに続発する角膜糜爛，角膜潰瘍である。

　長期間眼科で治療を要した6例のうち，1例は角膜穿孔をおこして失明したが，他の5例は治療を続けながら視力を保つことができた。

　治療は，生食水，代用涙液，抗生剤，ステロイド剤，ビタミンA油剤などの点眼，ゼラチンロッドによる涙点閉鎖，フィブロネクチン点眼，ステロイド涙腺注射，結膜被覆，水泳眼鏡装用などを症状に応じて行った。

We report 6 cases with ocular complications of graft-versus-host disease following allogenic bone marrow transplantation. Hypolacrimation was the cardinal feature in the series. Superficial puntate keratopathy was the initial occurrence, which developed later into larger corneal erosion or ulcer.

We treated the cases with following measures. 1. Topical tear-substitute, antibiotics, corticostero-ids, vitamin A oil and fibronectin obtained from autoserum. 2. Occlusion of the lacrimal canaliculi with gelatin rod. 3. Injection of corticosteroids into or around the lacrimal gland. 4. Use of conjunctival flap in case of corneal perforation. 5. Continued wear of swimming goggles to diminish evaporation of tear fluid from the ocular surface.

One patient in the series lost vision due to exten-sive corneal ulcer with eventual perforation. Other cases followed favorable courses with the above measures, of which gelatin rod method seemed to be most effective. Although this procedure had to be repeated every few weeks because of recanaliza-tion of the canaliculi, it was our preferred method of treatment as it caused least damage to the tissue.