Ex-PRESSTM併用濾過手術とiCare HOME2を活用した眼圧日内変動管理の有用性：原発開放隅角緑内障の1例

Efficacy of intraocular pressure diurnal fluctuation management using Ex-PRESSTM filtering surgery combined with iCare HOME2: a case report of primary open-angle glaucoma

要約　目的：自己眼圧測定デバイスiCare HOME2を活用し，原発開放隅角緑内障（POAG）の症例において，Ex-PRESS^TM併用濾過手術前後の眼圧日内変動を検討した。

対象と方法：症例は61歳，男性。iCare HOME2を用いて起床時仰臥位，起床時坐位，夜間坐位の眼圧を測定し，術前後で比較した。

結果：術前8か月間の眼圧の平均は起床時仰臥位で18.0±2.4mmHg，起床時坐位で13.9±1.9mmHg，夜間坐位で13.8±2.1mmHgであったが，Ex-PRESS^TM併用濾過手術1か月後の眼圧は起床時仰臥位で11.9±1.5mmHg（p＜0.0001），起床時坐位で9.1±1.6mmHg（p＜0.0001），夜間坐位で9.7±1.5mmHg（p＜0.0001）と，術前の眼圧と比較し有意な眼圧下降が認められていた。

結論：iCare HOME2は診療時間外の眼圧変動を可視化し，適切な治療戦略立案を支援するツールである。また，本手術は眼圧安定化に有効であった。

Abstract　Purpose：To evaluate the effectiveness of Ex-PRESS^TM combined filtration surgery in a case of primary open-angle glaucoma（POAG） by utilizing the self-measurement device iCare HOME2 to assess intraocular pressure（IOP） diurnal variation.

Subjects and Methods：A 61-year-old male patient was monitored using iCare HOME2 to measure IOP in the supine position upon waking, seated position upon waking, and seated position at night, both preoperatively and postoperatively.

Results：Preoperative IOP values were 18.0±2.4 mmHg in the supine position upon waking, 13.9±1.9 mmHg in the seated position upon waking, and 13.8±2.1 mmHg at night. One month after Ex-PRESS^TM combined filtration surgery, the IOP values were significantly lower, with 11.9±1.5 mmHg（p＜0.0001） in the supine position upon waking, 9.1±1.6 mmHg（p＜0.0001） in the seated position upon waking, and 9.7±1.5 mmHg（p＜0.0001） at night, compared to the IOP values from the seven months prior to surgery.

Conclusion：iCare HOME2 effectively visualizes IOP fluctuations outside of clinic hours and supports the formulation of appropriate treatment strategies. This surgery was effective in stabilizing IOP.