緑内障手術の視機能への影響

The effect of glaucoma surgery on postoperative visual function

要約　目的：緑内障手術後の視機能の検討。対象と方法：深部強膜切除およびシュレム管外壁開放術（サイヌソトミー）併用線維柱帯切開術単独（LOT）群43例54眼，線維柱帯切除術単独（LEC）群37例40眼の術後の視力，惹起乱視，高次収差，コントラスト感度，涙液層について検討した。結果：LOT群のほうがLEC群よりも視力回復が有意に早かった（p＜0.05）。高次収差（瞳孔径4mm）はLOT群0.28±0.2，LEC群0.47±0.3でLEC群のほうが有意に大きく（p＜0.05），惹起乱視もLEC群で有意に増加していた（p＜0.01）。両群とも，術後視力は良好でMD≧－12Dでもコントラスト感度が低下している症例があった。LEC群では涙液油層分布が不整になる傾向があり，それらの症例では高次収差が大きい傾向があった。結論：緑内障術後では視力良好な症例でも視機能が低下している可能性がある。

Abstract.　Purpose：To report the effect of glaucoma surgery on visual function. Cases and Method：This retrospective study was made on 94 eyes of glaucoma. Trabeculectomy was performed on 40 eyes. The other 54 eyes received deep sclerotomy, sinusotomy, and trabeculotomy. All the cases were followed up for 6 months or longer. Results：The visual acuity recovered earlier in eyes receiving combined surgery than those receiving trabeculectomy alone（p＜0.05）. Higher-order aberrations with pupillary diameter of 4mm were 0.28±0.2 after trabeculectomy alone and 0.47±0.3 after combined surgery. The difference was significant（p＜0.05）. Surgically induced astigmatism was greater in the latter group（p＜0.01）. Contrast sensitivity was decreased in some eyes that had good postoperative visual acuity with MD greater than －12dB. There was a tendency for eyes after combined surgery to show irregular precorneal film. These eyes tended to have greater higher-order aberrations. Conclusion：After filtrating surgery for glaucoma, some eyes may show decreased visual function in spite of good visual acuity.