血管新生緑内障に対するマイトマイシンC併用線維柱帯切除術の長期手術成績

Long-term outcome of trabeculectomy with adjunct mitomycin-C for neovascular glaucoma

要約　目的：血管新生緑内障に対するマイトマイシンC（MMC）併用の線維柱帯切除術の長期成績の報告。対象と方法：MMC併用の線維柱帯切除術を受けた血管新生緑内障50眼と原発開放隅角緑内障37眼を対象とした。血管新生緑内障50眼中38眼が過去に硝子体手術を受け，無硝子体眼であった。術後成績の評価では，Kaplan-Meier生命表を用い，目標眼圧を20mmHgに設定した。結果：3年後の生存率は，点眼不使用例では血管新生緑内障32.3％，原発開放隅角緑内障51.3％であり，統計学上有意差はなかった。眼圧降下薬併用例では，それぞれ59.7％と77.7％であり，血管新生緑内障での生存率が有意に低かった。血管新生緑内障で有硝子体眼と無硝子体眼とで生存率に有意の差がなかった。結論：MMC併用の線維柱帯切除術を受けた血管新生緑内障では3年後に約60％の症例で眼圧コントロールが可能であったが，原発開放隅角緑内障に比べ，治療成績が低かった。

Abstract.　Purpose：To evaluate the long-term outcome of trabeculectomy for neovascular glaucoma with adjunct use of mitomycin C. Objects and Method：This retrospective study was made on 50 eyes of neovascular glaucoma that received mitomycin C-assisted trabeculectomy. Vitrectomy had been performed on 38 eyes. Another series of similarly treated 37 eyes of primary open-angle glaucoma（POAG）served as control. Outcome after surgery was evaluated by survical curve analysis of Kaplan-Meier setting 20mmHg of intraocular pressure as criterium without topical medication. Results：The 3-year survival rate without medication was 51.3％ in POAG and 32.3％ in neovascular glaucoma. The difference was not significant. Survival rate with topical medication was 59.7％ and 77.7％ respectively. The difference was significant. There was no difference in 3-year survival rate between eyes with or without prior vitrectomy. Conclusion：Mitomycin C-assisted trabeculectomy was useful in neovascular glaucoma but was less effective than in POAG.