Q-switched Nd-YAGレーザーによる隅角切開術 第1報

Goniotomy with Q-switched Nd-YAG laser. Report 1

　Q-switched Nd-YAG　レーザーによる隅角切開術を行い，7眼中4眼で眼圧下降を得た．Dcvelopmental glaucoma 2例4眼では有効であった．先天緑内障の陳旧例およびSturge-Weber症候群の症例では無効であった．しかし全例で隅角切開が得られたことから，原発先天緑内障の発症後早期の症例においては，特にその有効性が期待され，今後検討に価する方法と考える．

We treated 7 eyes (5 patients) with congenital glaucoma by Q switched Nd-YAG laser applied directly to the trabecular meshwork. The ages of the patients ranged from 7 to 46 years and averaged 25.6 years. Five eyes had previously been treated by surgical procedures including goniotomy and trabeculectomy.

Q-switched Nd-YAG laser (Microruptor II,Lasag) was used. With the use of gonioscopic lens (CGA 7, LASAG), the laser beam was applied anterior to the insertion of the iris. The power output was set at 5 to 7 mJ. A total of 20 to 40 shots, each shot comprising of a train of 5 to 9 pulses, were applied to one quandrant of the angle. Each pulse was of 12 ns duration and the spot size was 40 μm.

With each laser application, the iris root fell backwards and the ciliary band became visible. A slight oozing of blood appeared at the treated sites in all eyes but ceased spontaneously in a few minutes. Postoperative inflammatory reaction was minimum and the anterior chamber was clear in all the treated eyes within 24 hours. An immediate rise of intraocular pressure by more than 5 mmHg occured in 2 eyes. The intraocular pressure was equal or lower than the pretreatment level at 24 hours.

The intraocular pressure remained below 20 mmHg in 5 out of the 7 treated eyes with medica-tion for 2 to 12 weeks. The results in the present series are encouraging and seem to justify further attempts at treating primary congenital glaucoma using Q-switched Nd-YAG laser.