急性原発閉塞隅角症に対する初回外科治療の選択方法

Options in the initial treatment of acute primary angle-closure

要約　背景：急性原発閉塞隅角症に対する初回治療として，超音波乳化吸引術（PEA）でなく，レーザー虹彩切開術や周辺虹彩切除術が選択される場合がある。目的：これら3治療のいずれかを行った急性原発閉塞隅角症の報告。対象と方法：過去56か月間に急性原発閉塞隅角症で治療した30例34眼を検索した。男性8例10眼，女性22例24眼で，年齢は55～88歳（平均71歳）である。結果：初診から24時間以内に眼圧が正常化するか角膜が透明化した17眼には超音波乳化吸引術を行い，11眼にはレーザー虹彩切開術，6眼には周辺虹彩切除術を行った。この6眼での術前眼圧は，他の2群よりも有意に高かった。結論：保存的治療で角膜が透明化しない急性原発閉塞隅角症には周辺虹彩切除術を，透明化した症例には超音波乳化吸引術またはレーザー虹彩切開術を行うのがよい。

Abstract.　Purpose：To report profiles of eyes with acute primary angle-closure treated by laser iridotomy,peripheral iridectomy,or phacoemulsification as initial surgery. Cases and Method：This study was made on 34 eyes of 30 patients who were treated by us during the past 56 months. The series comprised 10 male and 24 female eyes. The age ranged from 55 to 88 years,average 71 years. Results：Phacoemulsification was performed on 17 eyes that showed normal intraocular pressure（IOL）or transparent cornea within 24 hours. Out of the other 17 eyes,11 eyes received laser iridotomy and 6 eyes received peripheral iridectomy. IOL before surgery in these 6 eyes was significantly higher than eyes in the other two groups. Conclusion：Peripheral iridectomy is the primary choice for acute primary angle-closure that fail to show clear cornea or normal IOL during the initial 24 hours of conservative treatment. Laser iridotomy or phacoemulsification may be applied that respond to treatment.