角膜移植術後の遷延性角膜上皮欠損でPCR法にて単純ヘルペスウイルスが検出された2例

Detection of herpes simplex virus by polymerase chain reaction in two cases of persistent epithelial defects following penetrating keratoplasty

　70歳と55歳男性の左眼に全層角膜移植術を行った。術前診断は，それぞれ真菌性角膜潰瘍と，虹彩切開術後の角膜浮腫であった。角膜移植後に拒絶反応が起こり，免疫抑制剤投与中に遷延性角膜上皮欠損が生じた。両症例とも，上皮欠損は母角膜と移植片にまたがり，創部に沿った不整な形で，典型的な上皮型角膜ヘルペスの所見ではなかった。しかし，角膜上皮のPCR法による検査で単純ヘルペスウイルスが検出され，アシクロビル投与で角膜上皮欠損が消失した。角膜疾患で臨床所見のみでは診断が困難な場合にPCRが有用であることを示す症例である。

We performed penetrating keratoplasty on one eye each of two males aged 70 and 55 years respectively. The preoperative diagnosis was fungal corneal ulcer in one case and corneal edema following iridectomy in the other. Graft rejection occurred following surgery. Persistent corneal epithelial defects developed after treatment with immunosup-pressive agents. The epithelial defects were irregular in shape and were located over the host-graft junction area. The findings were not characteristic for herpetic keratopathy. Herpes simplex virus was identified in the corneal epithelium processed by polymerase chain reaction (PCR). The corneal lesion subsided following acyclovir. These cases illustrate that PCR may be useful for corneal lesions when diagnosis is difficult by clinical manifestations alone.