緑内障手術後乱視の検討―線維柱帯切除術と非穿孔線維柱帯切除術の単独手術および白内障同時手術での比較

Corneal astigmatism after trabeculectomy and nonpenetrating trabeculectomy

74眼に緑内障手術を行い，手術前後の角膜形状と角膜乱視の変化を検索した。内訳は線維柱帯切除術33眼と非穿孔線維柱帯切除術41眼である。線維柱帯切除術単独13眼，線維柱帯切除術と白内障手術ならびに眼内レンズ移植術のトリプル手術を20眼，非穿孔線維柱帯切除術単独12眼，これと白内障手術ならびに眼内レンズ移植術のトリプル手術を29眼に行った。Cravy法による軸乱視量変化では，術後3か月ですべての術式で直乱視化した。Jaffe法では，術後3か月の惹起乱視量は，線維柱帯切除術トリプル手術例で最大，非穿孔線維柱帯切除術単独例で最小であった。線維柱帯切除術では惹起乱視量が非穿孔線維柱帯切除術よりも大きく，直乱視化した。非穿孔線維柱帯切除術群では術後3か月で直乱視化した。

We evaluated the corneal topography and corneal astigmatism before and after glaucoma surgery on 74 eyes. Trabeculectomy was performed on 33 eyes. Nonpenetrating trabeculectomy was performed on 41 eyes. Trabeculectomy was performed as single procedure on 13 eyes. It was performed as triple procedure including cataract surgery and intraocular lens implantation on 20 eyes. Nonpenetrating trabeculectomy was performed as single procedure on 12 eyes. It was performed as triple procedure on 29 eyes. When evaluated by Cravy's method,corneal astigmatism turned into vertical astigmatism 3 months after surgery in each of 4 groups. When evaluated by Jaffe's method,induced astigmatism 3 months after surgery was the greatest in triple surgery with trabeculectomy and was minimum after nonpenetrating trabeculectomy alone. Thus,induced astigmatism was greater after trabeculectomy than nonpenetrating one. Nonpenetrating trabeculectomy appeared to be safer because of lesser effect to corneal endothelium.