Descemet膜小穿孔を用いた濾過手術と線維柱帯切除術との降圧効果および安全性の比較

Comparison of safety and hypotensive effect between trabeculectomy and microperforation of Descemet membrane

要約　目的：線維柱帯切除術とDescemet膜小穿孔による濾過手術の安全性と効果の比較。対象と方法：薬物治療でも眼圧が22mmHg以上の開放隅角緑内障50名50眼を対象とした。25眼にはDescemet膜小穿孔による濾過手術，25眼には線維柱帯切除術を行い，12か月の経過を観察した。結果：術前眼圧はDescemet膜小穿孔群24.6±2.7mmHg，線維柱帯切除術群24.8±2.6mmHgで，有意差はなかった。術後の眼圧はDescemet膜小穿孔群で3か月後11.4±2.0mmHg，6か月後11.8±2.4mmHg，12か月後12.6±2.7mmHgで，線維柱帯切除術群でもほぼ同様であり，両群間に有意差はなかった。合併症として，線維柱帯切除術群で浅前房が4眼（16％），低眼圧が5眼（20％）に生じ，いずれもDescemet膜小穿孔群より有意に高率であった（p＝0.0371，p＝0.0187）。Descemet膜小穿孔群では術中のDescemet膜穿孔が1眼にあった。結論：緑内障眼に対し，Descemet膜小穿孔による濾過手術と線維柱帯切除術とは同様の眼圧下降効果があった。前者は後者よりも合併症が少なかった。

Abstract.　Purpose：To report the safety and effect of trabeculectomy and filtering surgery by microperforation of Descemet membrane. Cases and Method：This prospective study was made on 50 eyes of 50 patients of open-angle glaucoma. Twenty-five eyes received microperforation of Descemet membrane and the other 25 eyes received trabeculectomy. Cases were followed up for 12 months after surgery. Results：Intraocular pressure（IOP）averaged 24.6±2.7 mmHg in microperforation group and 24.8±2.6 mmHg in trabeculectomy group. There was no difference between the two groups. In microperforation group, IOP averaged 11.4±2.0 mmHg after 3 months, 11.8±2.4 mmHg after 6 months, and 12.6±2.7 mmHg after 12 months. Findings were similar in trabeculectomy group with no significant difference. Four eyes（16％）developed shallow anterior chamber after trabeculectomy. Five eyes（20％）developed ocular hypotension. Both incidences were higher than microperforation group（p＝0.0371, p＝0.0187）. Descemet membrane perforated during surgery in one eye in microperforation group. Conclusion：Trabeculectomy and microperforation of Descemet membrane result in similar hypotensive effect. Postoperative complication was more frequent in the former.