ジクロフェナクナトリウム点眼が原因と考えられた角膜潰瘍の2例

Two cases of corneal ulcer following instillation of diclofenac ophthalmic solution

　抗炎症薬ジクロフェナクナトリウムを点眼中の2例2眼に角膜潰瘍が生じた。1例は76歳女性で，右眼に白内障術前の処置として本剤の点眼が1日4回行われ，点眼開始から5日後に角膜中央のやや下方に深い潰瘍が生じた。涙液分泌減少を思わせる所見が同時にあった。その後，角膜が穿孔し，深層角膜移植が行われた。他の1例はアトピー性皮膚炎，気管支喘息，精神発達遅延がある23歳男性で，右眼網膜剥離のためにシリコーンオイルによる硝子体置換術を受け，シリコーンオイル除去手術後に本剤，オフロキサシン，ベタメタゾンをそれぞれ1日4回点限していた。点眼開始から18日後に内下方の角膜に潰瘍が生じた。本剤の点眼を中止し，抗菌薬と副腎皮質ステロイド薬の点眼で上皮再生が得られた。

We observed two cases of corneal ulcer following topical diclofenac sodium. The first case, a 76-year-old woman, started instillation of diclofenac 4 times a day prior to cataract surgery in her right eye. Five days later, a deep ulcer had developed inferior to the central cornea. Both eyes also showed findings suggestive of decreased tear secre-tion. Deep lamellar keratoplasty was performed for later corneal perforation. The second case, a 23-year-old man, had atopic dermatitis, bronchial asthma and mental retardation. His right eye had received surgery for retinal detachment with silicone oil implantation. Following removal of silicone oil, he started instillation, 4 times a day, of diclofenac, oflox-acin and betamethasone. Eighteen days later, an ulcer was detected in the inferior-nasal quadrant of the cornea. The corneal ulcer healed following withdrawal of diclofenac and combined use of antimicrobial agents and corticosteroid.