硝子体手術既往眼に施行した線維柱帯切除術の成績

Outcome of trabeculectomy in eyes with previous pars plana vitrectomy

要約　目的：硝子体手術の既往がある眼への線維柱帯切除術の効果の報告。対象と方法：過去に硝子体手術を受け，初回線維柱帯切除術が行われた28例32眼を対象とした。緑内障は血管新生緑内障19眼，血管新生がない緑内障13眼で，点眼または内服でも追加手術，眼圧21mmHg以上，または失明したものをKaplan-Meier法による死亡と定義し，3年生存率を求めた。結果：線維柱帯切除術後の3年生存率は全体で71.4％，血管新生緑内障眼56.1％，非血管新生眼74.6％で，両群間に有意差はなかった。合併症または追加手術は血管新生緑内障眼で多かった。濾過胞形成と視力転帰は血管新生眼と非血管新生眼とで差がなかった。結論：硝子体手術の既往がある眼への線維柱帯切除術では，術後3年間での眼圧下降効果が約70％で得られた。

Abstract.　Purpose：To report the outcome of trabeculectomy in eyes with past history of pars plana vitrectomy. Cases and Method：This retrospective study was made on 32 eyes of 28 patients who received trabeculectomy after previous vitrectomy. Rubeosis was present in 19 eyes and absent in 13 eyes. The eyes were defined as failure when additional surgery was needed,intraocular pressure（IOP）remained above 21 mmHg with medication,or blindness had set in. Results：Rate of survival after 3 years was 71.4％ in the whole series,56.1％ in eyes with neovascular glaucoma,and 74.6％ in eyes without rubeosis. There was no significant difference among the two groups. Eyes with neovascular glaucoma needed more additional surgery and showed more complications. Both groups were similar regarding bleb formation or visual outcome. Conclusion：Trabeculectomy in eyes with previous vitrectomy showed hypotensive effect in 70％ of cases after 3 years.