晩発性濾過胞漏出に対する羊膜を用いた濾過胞再建術

Revision of filtering bleb with late-onset leakage by transplantation of amniotic membrane

要約　難治性の晩発性房水漏出を繰り返した濾過胞を，羊膜を使って修復した。77歳女性と60歳男性の各1眼で，緑内障に対してマイトマイシンC併用線維柱帯切除術が行われた。血管に乏しい壁の薄い濾過胞が形成され，房水漏出を繰り返し，濾過胞炎があった。保存的療法や濾過胞内への自家血注入でも房水漏出が消失しなかった。両症例とも，当初の手術から17か月後に羊膜片を濾過胞部に縫着した。1例では羊膜の上皮を上，ほかの1例では下にした。術後，両症例とも濾過胞が形成され房水漏出はなく，眼圧も良好に維持された。羊膜を用いる濾過水疱修復術は，房水漏出を止めるとともに濾過胞維持の効果がある。

Abstract.　We reconstructed the late-onset leaking bleb in two eyes by transplanting amniotic membrane. One case was a 77-year-old woman and the other a 60-year-old man. Both had received trabeculectomy with mitomycin C for glaucoma in one eye each. After surgery,thin and avascular bleb had formed with blebitis and leakage of the aqueous. Conservative treatments and intrableb injection of blood were futile. Seventeen months after surgery,both cases received transplantation of amniotic membrane covering the filtering bleb. The amniotic membrane was placed with its epithelium outside in one eye and inside in the other. After this procedure,the filtering bleb was formed with no leakage and with well-maintained intraocular pressure. Transplantation of amniotic membrane was thus useful in preventing leakage and in maintaining the filtering bleb.