角膜移植の対象疾患と術式の変遷

Changing trends in the indication and surgical approach of keratoplasty

要約　目的：過去17年間の角膜移植の原疾患と術式の推移の報告。対象と方法：1992～2008年に行った角膜移植3,950例を，1992～1996年の5年間，1997～2002年の6年間，2003～2008年の6年間の3期間について解析した。結果：原疾患では水疱性角膜症が21.3％→24.9％→36.5％と増加し，角膜混濁が30.0％→24.6％→22.6％と減少した。術式では深層層状角膜移植と角膜内皮移植が増加し，全層角膜移植と白内障との同時手術が42.7％→25.1％→18.6％と減少した。結論：原疾患の変化と術式の進歩に伴い，角膜移植の適応と術式は，より安全で術後視機能を重視する方向に変化している。

Abstract.　Purpose：To report changes in keratoplasty regarding causative lesions and surgical methods. Objects and Method：This review was made on consecutive series of 3,950 cases of keratoplasty during 17 years through 2008. The period was divided into 3 groups：5 years from 1992 to 1996,6 years from 1997 to 2002,and 6 years from 2003 to 2008. Results：As a major causative lesion,bullous keratopathy increased from 21.3％ through 24.9％ to 36.5％ during the 3 periods. Corneal opacity decreased from 30.0％ through 24.6％ to 22.6％. Deep anterior lamellar keratoplasty and endothelial keratoplasty showed an increase. Penetrating keratoplasty with simultaneous cataract surgery decreased from 42.7％ through 25.1％ to 18.6％ during the period. Conclusion：Indications and surgical approach of keratoplasty have changed during the past 17 years. There has been a trend towards safety and postoperative visual function.