血管新生緑内障に対する非穿孔性線維柱帯切除術変法の効果

Outcome of modified nonpenetrating trabeculectomy for neovascular glaucoma

要約　目的：血管新生緑内障に対する非穿孔性線維柱帯切除術変法の結果の報告。症例と方法：過去7年間に本手術を行った18例22眼を対象とした。すべて開放隅角であり，年齢は49～69歳（平均61歳）であった。原因疾患は18眼が糖尿病網膜症，4眼が網膜中心静脈閉塞症であった。10眼には単独手術，12眼には白内障と硝子体手術を併用した。結果：平均眼圧は術前が34.4±9.6mmHg，術後は18.3±7.0mmHgで，有意に下降した（p＜0.0001）。眼圧が20mmHg以下の生存率は，12か月後77％，24か月後72％，42か月後58％であった。過剰濾過や術後感染などの重篤な合併症はなかった。結論：開放隅角期の血管新生緑内障に対し，非穿孔性線維柱帯切除術変法は安全で有効である。

Abstract.　Purpose：To report the outcome of modified nonpenetrating trabeculectomy for neovascular glaucoma. Cases and Method：This retrospective study was made on 22 eyes of 18 patients who received this surgery. The age ranged from 49 to 69 years,average 61 years. Neovascular glaucoma was secondary to diabetic retinopathy in 18 eyes and to central retinal vein occlusion in 4 eyes. The chamber angle was open in all the eyes. Ten eyes received this surgery only and 12 eyes received additional cataract and vitreous surgery. Results：Intraocular pressure（IOP）averaged 34.4±9.6 mmHg before surgery and 18.3±7.0 mmHg after surgery. The difference was significant（p＜0.0001）. Survival rate of IOP below 20 mmHg was 77％ after 1 year of surgery,72％ after 2 years,and 58％ after 3 years 6 months. There was no significant postoperative complication including overfiltration or infection at the site of surgery. Conclusion：Modified nonpenetrating trabeculectomy was safe and effective for open-angle neovascular glaucoma.