極小切開白内障手術と緑内障同時手術

Simultaneous glaucoma and microincision cataract surgery

極小切開白内障手術，眼内レンズ挿入術と緑内障手術とを10眼に行った。緑内障手術として，落屑緑内障4眼には線維柱帯切開術，続発緑内障5眼と新生血管緑内障1眼には線維柱帯切除術を行った。線維柱帯切開術では下方でこれを行って眼内レンズを挿入し，上方結膜を温存した。線維柱帯切除術では輪部基底結膜弁が白内障手術の邪魔にならず，強膜弁下で眼内レンズを挿入するので，熱創や張力による創口の損傷を避けることができた。強膜弁は鼻側と耳側のいずれにも作製できた。線維柱帯切開術と線維柱帯切除術とも，右利きの術者の場合，右眼または左眼のいずれにも同じ方法を使えるので左眼の手術が容易になり，瞼裂が狭い眼でも支障がなかった。

We performed simultaneous microincision cataract surgery, intraocular lens（IOL）implantation, and glaucoma surgery on 10 eyes. Trabeculotomy was performed on 4 eyes of exfoliation glaucoma. Trabeculectomy was performed on 5 eyes of secondary glacoma and one eye of neovascular glaucoma. Trabeculotomy could be placed on 6 o'clock position. Conjunctiva in the upper quadrant could be left intact by inserting IOL through the trabeculotomy opening. Limbal-based conjunctival flap in trabeculectomy did not interfere cataract surgery. IOL could be inserted through the scleral opening, so that the scleral wound was spared from damage by burns or stretching. The scleral wound could be placed either temporally or nasally. In both glaucoma procedures, the approach in the left eye was easy for right-handed surgeon. This method was possible for deep-set eyes.

Rinsho Ganka（Jpn J Clin Ophthalmol）60（8）：1379-1383, 2006