原発閉塞隅角症の予防的白内障手術における角膜内皮障害予測因子

Predictive factors for corneal endothelial loss after prophylactic lens extraction for primary angle closure

要約　目的：原発閉塞隅角症に対する予防的水晶体摘出が角膜内皮に及ぼす要因の解析。対象と方法：単一術者により白内障手術を行った連続例676眼のうち，術後3か月の内皮が計測できた378眼を検索した。内訳は男性99眼，女性279眼で，年齢は34～94歳（平均75歳）であった。このうち狭隅角に対する予防として水晶体摘出を行ったのは57眼である。ステップワイズ重回帰分析で，術前の各因子と内皮細胞面積の変化との相関を検討した。結果：術後の角膜内皮障害と有意に関係する術前因子は，眼軸長，核硬度，粘弾性物質の使用，年齢，性であった（p＜0.0001，R²＝0.21）。前房深度，角膜屈折力，眼圧，矯正視力，瞳孔径，落屑症候群の有無とは関係がなかった。結論：核硬化や内皮障害が進行する以前のソフトシェル法による早期白内障手術が，短眼軸女性での内皮障害を軽減する可能性がある。

Abstract.　Purpose：To identify preoperative factors associated with corneal endothelial loss after prophylactic lens extraction for primary angle closure. Cases and Method：This prospective study was made on 378 out of consecutive 676 eyes that received lens extraction by one surgeon during the past 6 years. Specular microscopy was performed in the 378 eyes three months after surgery. The series comprised 99 males and 279 females. Their age ranged from 34 to 94 years,average 75 years. Lens extraction was performed in 57 eyes as prophylaxis for narrow chamber angle. Stepwise multiple regression analysis was used to evaluate the correlation between preoperative factors and corneal endothelial damage. Results：Postoperative endothelial loss was significantly correlated with age,gender,axial length,hard nucleus,and use of viscoelalstic material（p＜0.0001,R²＝0.21）. It was not correlated with anterior chamber depth,corneal refraction,visual acuity,intraocular pressure,pupillary diameter,or presence of exfoliation. Conclusion：Corneal endothelial damage in females can be avoided by early cataract surgery using soft-shell technique.