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要約 目的:網膜剝離に対する網膜輪状締結術既往のある強度近視眼に,アーメド緑内障バルブインプラント(AGV)を安全に留置する方法を報告する。
症例:56歳,男性。左眼軸長30.99mmの強度近視である。左眼の網膜剝離に対し30歳時に網膜輪状締結術(シリコーンストリップ#220,バンド#240,スリーブ#270使用),硝子体手術を施行した。47歳時に白内障手術,55歳時に網膜剝離再発に対し再硝子体手術とシリコーンオイル注入,56歳時にシリコーンオイル抜去を施行した。その後,左眼圧は44mmHgとなり,以下のAGV手術を施行した。角膜輪部から11mmの位置にあるシリコーンバックルを6mm幅で切除し,強膜上に残したバックルの断端とAGVプレートを7-0ナイロン糸で縫合し,AGVチューブを毛様体扁平部に留置した。術後3か月時点で左眼圧は7mmHgへ下降した。
結論:網膜輪状締結術既往のある強度近視眼に対し,バックルの部分切除とAGVのバックル断端への固定を行うことで,バックルとAGVの干渉を避け,かつ強膜への通糸を行わずに安全に眼圧下降を得られた。
Abstract Purpose:To describe a safe method for implanting the Ahmed Glaucoma Valve(AGV) in highly myopic eyes with a history of encircling surgery for retinal detachment.
Case:A 56-year-old man with high myopia(axial length:30.99 mm) in the left eye. At 30 years of age, encircling surgery was performed using silicone strips(#220, #240, and #270) for retinal detachment, followed by vitrectomy for recurrence. Cataract surgery was performed at 47 years of age. Retinal detachment recurred, requiring additional vitrectomy and silicone oil injections at 55 years of age. Silicone oil was removed at a concentration of 56. Subsequently, intraocular pressure in the left eye increased to 44 mmHg, necessitating AGV implantation. The silicone-encircling band was located 11 mm from the corneal limbus, and a 6-mm segment was excised. The remaining edges of the encircling band were left on the sclera, to which the AGV plate was sutured and secured with a 7-0 nylon thread. The AGV tube was inserted into the pars plana. Three months postoperatively, the intraocular pressure(IOP) in the left eye decreased to 7 mmHg.
Conclusion:IOP reduction was safely achieved through partial buckle resection and AGV fixation to the residual buckle in highly myopic eyes with a history of encircling surgery. This method prevents interference between the buckle and AGV while avoiding direct sclera suturing, thereby reducing the risk of scleral perforation.

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