結膜切開部位の異なるtrabeculectomyの比較

Comparison of different conjunctival incisions in trabeculectomy

目的：結膜切開部位が異なる線維柱帯切除術の効果の比較。症例と方法：深層強膜トンネルを用い，同一術者による線維柱帯切除術を緑内障19眼に行った。内訳は原発開放隅角緑内障15眼と続発緑内障3眼である。9眼には円蓋部基底結膜切開，9眼には輪部基底結膜切開を用いた。強膜縫合は同じ本数で同じ位置に行い，laser suturelysisは行わなかった。結果：術前眼圧は円蓋部基底切開群27.7±9.2mmHg，輪部基底切開26.8±9.6mmHgで，両群間に有意差はなかった。術後1か月から6か月までの眼圧は，すべて円蓋部基底切開群よりも輪部基底切開群が有意に低かった（p＜0.05）。6か月後の眼圧は円蓋部基底切開群12.9±4.0mmHg，輪部基底切開群8.6±3.7mmHgであった。結論：深層強膜トンネルを用いた線維柱帯切除術では，円蓋部基底結膜切開よりも輪部基底結膜切開で良好な眼圧下降効果が得られた。

Purpose：To compare fornix-based and limbal-based conjunctival flaps in trabeculectomy. Cases and Methods：Trabeculectomy with deep scleral tunnel was performed on 19 eyes. The series comprised 15 eyes of primary open-angle glaucoma and 3 eyes of secondary glaucoma. The conjunctival incision was fornix-based in 9 eyes and limbal-based in 9 eyes. Other surgical techniques,including scleral suture,were the same throughout. No eye received laser suturelysis. Findings：Intraocular pressure（IOP）before surgery averaged 27.7±9.2 mmHg in fornix-based group and 26.8±9.6 mmHg in limbal-based group. There was no significant difference between both groups. IOP during 1 to 6 months after surgery was consistently lower in limbal-based than in fornix-based group（p＜0.05）. IOP 6 months after surgery averaged 12.9±4.0 mmHg in fornix-based group and 8.6±3.7 mmHg in limbal-based group. Conclusion：After trabeculectomy,better hypotensive effect was obtained by limbal-based than fornix-based conjunctival incision.