マイトマイシンC塗布を併用したトラベクレクトミー後に発症した角膜潰瘍

A case of corneal ulcer after trabeculectomy with intraoperative topical mitomycin C

　マイトマイシンC （MMC）塗布を併用したトラベクレクトミー術後に角膜周辺部潰瘍を併発した症例を報告した。症例は2回の緑内障手術を受けていた。角膜潰瘍は強膜弁を作成した周辺部角膜に術後2日目に認められ，凹窩（dellen）として発症しその深さは1／2〜1／3角膜厚であり，部分的な角膜上皮欠損を認め，その後改善することなく角膜潰瘍へと増悪し，結膜と血管の侵入を残して治癒した。経過中過大な濾過胞が認められた。これはMMCの作用としての線維芽細胞抑制によるコラーゲン産生能の低下や血流低下，または過大濾過胞による涙液交換障害のためと思われた。

A 14-year-old male was referred to us for bilateral developmental glaucoma. He had been treated twice by trabeculotomy for both eyes 7 years before. We performed trabeculectomy for both eyes as follows. After preparing a limbal based conjuctival flap, a 4×4mm double scleral flap was dissected into the clear cornea. A sponge was soaked in a 0.2mg/ml solution of mitomycin C and was placed between the conjunctiva and the scleral flap for 5 minutes. After the area was then copiously rinsed with saline solution, trabeculectomy was performed after the standard procedure. Both eyes devekloped marginal corneal ulcer adjacent to the well-formed bleb 2 days after surgery. The ulcer, which was 1 to 2mm in length and involved one-half of corneal thickess, showed little tendency to improvement. It appeared that mitomycin C inhibited fibroblast proliferation and reduced production of collagen fibers in the cornea.