隅角癒着解離術第1報

Goniosynechialysis as a new treatment for chronic angle closure glaucoma

　慢性閉塞隅角緑内障で器質的周辺虹彩前癒着を生じた隅角を再び開放する新しい術式を考案した．あらかじめ硝子体中心部から少量の硝子体を切除し，輪部小切開創から隅角癒着解離術用の注入針を挿入し前房を深く形成しながら隅角癒着を剥離する．6カ月以上観察できた8例9眼の成績からこの手術が難治な閉塞隅角緑内障の手術的治療として，安全でかなり有効な方法であることがわかった．

A new surgical technique is presented to convert the non-functioning closed angle in chronic angle closure glaucoma to functioning open angle. After removing a small amount of core vitreous by vit-rectomy, a specially designed infusion needle with blunt spatula on its tip is inserted into the anterior chamber. The peripheral anterior synechia is gently released under direct observation through a gonio-prism. This technique allows to open at least one quandrant of the closed angle in a phakic eye in one surgical session.

This procedure was performed on 9 eyes (8 cases) with recalcitrant chronic angle closure glaucoma. Peripheral iridectomy had been performed in 8 of these 9 eyes. The postoperative period after this procedure ranged 6 months or more. The procedure was a success in 7 eyes. The intraocular pressure was controlled below 21mmHg without medication in 3 eyes, and with topical medication in additional l eyes. No significant complications were encoun-tered during or after surgery. It is our impression that this procedure is much easier to perform and more effective in aphakic than in phakic eyes.