原発開放隅角緑内障に対する初回Schlemm管外壁開放術併用線維柱帯切開術の長期成績

Long-term outcome of primary trabeculotomy with sinusotomy for primary open-angle glaucoma

要約　目的：原発開放隅角緑内障に対するSchlemm管外壁開放術併用線維柱帯切開術（LOT＋SIN）の長期成績の報告。対象と方法：有水晶体眼で初回LOT＋SINを施行した90例90眼で上方群17眼，下方群73眼の手術成績を比較した。平均術前眼圧は上方群21.2，下方群20.3mmHg，平均観察期間は上方群9.9，下方群7.5年であった。結果：術後平均眼圧は術後5年上方群14.2，下方群15.3，術後10年上方群14.7，下方群14.9mmHg，Kaplan-Meier生存解析の20mmHg生存率は上方群0.88，下方群0.82，16mmHg生存率は上方群0.42，下方群0.27，14mmHg生存率は上方群0.11，下方群0.18で，両群間に有意差はなかった。結論：LOT＋SINは術後長期でも眼圧下降効果が持続し，上方群と下方群の間に術後成績に差はなかった。

Abstract.　Purpose：To report long-term outcome of simultaneously performed primary trabeculotomy with sinusotomy for primary open-angle glaucoma（POAG）. Cases and Method：This study was made on 90 eyes of 90 cases who received trabeculotomy with sinusotomy as the initial surgery for POAG. Surgery was performed in the upper sector in 17 eyes and in the lower sector in 73 eyes. Intraocular pressure（IOP）averaged 21.2 mmHg in the former group and 20.3 mmHg in the latter. Follow-up period averaged 9.9 years in the former group and 7.5 years in the latter. Results：IOP after 5 years averaged 14.2 mmHg in the former group and 15.3 mmHg in the latter. The difference was not significant. IOP after 10 years averaged 14.7 mmHg in the former group and 14.9 mmHg in the latter. The difference was not significant. There were no differences between the two groups regarding the rate of survival after Kaplan-Meier when the point of death was set at 20 mmHg, 16 mmHg, or 14 mmHg. Conclusion：IOP was well-maintained for 5 or 10 years after trabeculotomy with sinusotomy in eyes with POAG. There was no difference in the surgical outcome between eyes that received surgery in the upper or lower sector.