眼内レンズ毛様溝縫着術の手術成績

Outcome of transscleral sulcus fixation of intraocular lens

要約　目的：眼内レンズ（IOL）を毛様溝に縫着した症例群の報告。対象：過去52か月間に白内障手術を行った3,055眼のうち，水晶体脱臼は35眼（1.1％）にあり，17例19眼にIOL毛様溝縫着をした。縫着が必要になった原因は，偽落屑症候群7眼，医原性5眼，外傷3眼，アトピー性皮膚炎2眼，Marfan症候群2眼である。結果：術後平均26か月での視力は全例で良好であった。平均－0.71Dの屈折ずれがあった。角膜惹起乱視は，強角膜切開幅が7～12mmの7眼では平均1.38D，3～4mmの12眼では0.65Dであり，有意差があった（p＝0.047）。角膜内皮減少率は平均11.8％で，前半の10眼では17.7％，後半の9眼では5.2％であり，有意差があった（p＝0.029）。虹彩捕捉の合併が13眼中4眼にあり，これ以後の6眼では周辺部虹彩切除術を予防的に行ったが，1眼では再発を繰り返した。結論：水晶体脱臼へのIOL毛様溝縫着術は比較的小切開創で惹起乱視が減少し，周辺部虹彩切除術の併施で虹彩捕捉が予防できた。

Abstract.　Purpose：To report the outcome of transscleral sulcus fixation of intraocular lens（IOL）. Cases：This review was made on 3,055 eyes that received cataract surgery during the past 52 months. Luxation of the lens developed in 35 eyes（1.1％）. Sulcus fixation of IOL was made on 19 eyes of 17 cases. The underlying cases included pseudoexfoliation syndrome 7 eyes, iatrogenic factors 5 eyes, trauma 3 eyes, atopic dermatitis 2 eyes and Marfan syndrome 2 eyes. Results：All the eyes showed good visual acuity after an average of 26 months. Surgically induced astigmatism averaged 1.38 diopters in 7 eyes after sclerocorneal incision of 7 to 12 mm and 0.65 diopters after 3 to 4 mm. The difference was significant（p＝0.047）. Corneal endothelial cells decreased by an average of 11.8％. The decrease averaged 17.7％ in the initial 10 eyes and 5.2％ in the latter 9 eyes. The difference was significant（p＝0.029）. Iris capture occurred in 4 out of initial 13 eyes（31％）. The latter 6 eyes received prophylactic peripheral iridectomy. Iris capture recurred in one of the 6 eyes. Conclusion：Sclerocorneal incision resulted in decreased surgically induced astigmatism in sulcus fixation of IOL. Peripheral iridectomy was effective in preventing iris capture.