先天白内障術後の長期経過

Longterm outcome of surgery for congenital cataract

要約　目的：先天または発達白内障術後の長期経過の検討。対象と方法：過去30年間に当科で手術を行い，10年以上経過観察ができた15歳以下の41例71眼を対象とした。術式は経角膜輪部水晶体切除または吸引術で，前部硝子体切除術を併用した。結果：術後最高視力は，両眼性で生後6か月以内の手術群が，片眼性で生後3か月以内に手術群よりも良好であった（p＝0.039）。緑内障が9例13眼（18％）に生じ，うち10眼には小角膜などの眼合併症があった。緑内障は13眼中6眼（46％）で術後10年以降に発症した。網膜剝離はなかった。結論：先天または発達白内障に対する手術後の合併症である緑内障は，術後10年以上を経て生じることがあり，注意が必要である。

Abstract.　Purpose：To retrospectively evaluate the longterm outcome of surgery for congenital or developmental cataract. Cases and Methods：We evaluated 71 eyes of 41 patients who received surgery before the age of 15 years during the past 30 years and were followed up for 10 years or longer. Surgery was performed by limbal approach,lensectomy or aspiration,and anterior vitrectomy. Results：The best postoperative visual acuity was better in patients with bilateral cataract operated before the age of 6months than in those with unilateral cataract operated before the age of 3months（p＝0.039）. Glaucoma developed in 13 eyes of patients（18％）. It developed after 10 years or longer after surgery in 6 eyes（46％）. Ocular disorders including microcornea were present in 10 of the 13 eyes. There was no case of retinal detachment throughout. Conclusion：Glaucoma was a major complication of surgery for congenital or developmental cataract. Due attention is necessary because it may develop more than 10 years after surgery.