涙管チューブ挿入術前後の涙液動態の変化

Changes in tear fluid dynamics after insertion of lacrimal duct tube

要約　目的：涙管チューブ挿入術（SGI）前後による涙液動態についての報告。対象と方法：涙道閉塞症に対し，SGIを施行した22例30眼（平均69.7±5.6歳，男性9例，女性13例）を対象とした。術前，術後2か月（涙管チューブ留置），術後3か月（涙管チューブ抜去後）における，Schirmer値，涙液メニスカス高（TMH），涙液油層のGrade分類の結果について検討した。結果：TMHは術後2か月（p＝0.021，paired-t），3か月（p＝0.036，paired-t）ともに有意に改善し，涙液油層のGrade分類でも術後2か月（p＝0.003，Wilcoxon-t），3か月（p＝0.004，Wilcoxon-t）ともに有意に改善した。術前には正常範囲内とされるGrade 1，2の割合は24％であったが，術後2か月で48％，術後3か月で56％と増加した。結論：涙道閉塞症において涙液油層のGradeは高い傾向を示した。SGI後，TMHと涙液油層のGradeは有意に改善した。

Abstract.　Purpose：To report changes in tear fluid dynamics after insertion of sheath-guided intubation in eyes with lacrimal duct obstruction. Cases and Method：This study was made on 30 eyes of 22 patients who received insertion of sheath-guided intubation for lacrimal duct obstruction. The series comprised 9 males and 13 females. The age averaged 70 years. They were evaluated regarding tear meniscus height, grade of lipid layer of the tear fluid, and Schirmer test up to 3 months after intubation. Results：Tear meniscus height decreased signiflcantly 2 and 3 months after intubation. Grading of lipid layer of tear fluid improved significantly 2 and 3 months after intubation. Grade 1 by Schirmer test was present in 24％ of eyes before intubation, in 48％ after 2 months, and 56％ 3 months after intubation. Conclusion：Lipid layer of tear fluid was elevated in eyes with lacrimal duct obstruction. Its thickness and height tear meniscus decreased 2 and 3 months after intubation.