水晶体嚢性緑内障に対するレーザー隅角形成術の効果

Effect of laser trabeculoplasty for capsular glaucoma

　薬物コントロール不良の水晶体嚢性緑内障眼33例34眼（年齢54歳〜85歳（平均70.9歳））にlaser trabeculoplasty （LTP）を施行し3カ月〜3年9カ月（平均11.8カ月）の経過観察を行い有効性を検討した．LTP後成績は著効27眼（79.4％），有効4眼（11.8％）で両者を合せると31眼（91,2％）が成功と判定された．成功例ではLTP後，いずれの観察時期においても高度に有意（P＜0.001）の眼圧下降が得られた．なかでも12カ月目の，差の平均値±標準偏差は−16.4±6.4mmHgと最大であった．LTP前眼圧の高いもの（30mmHg≦）ではLTP後の眼圧下降幅（17.0±7.7mmHg （標準偏差））は最大を示し成功率（92.3％）も高かった．隅角線維柱帯の色素沈着の強いもの程，LTP後の眼圧下降が著明であった．LTP後のトノグラフィーC値は，LTP前に比べ高度に有意（P＜0.001）の改善がみられた．

　重大な合併症はなく，本症に対するLTPの有用性が示唆された．

We treated a series of 34 eyes with medically uncon-trollable capsular glaucoma using laser trabeculoplasty. Laser burns were evenly placed along the pigmented Schlemm's canal over the whole circumference. The number of burns ranged from 55 to 115, average 85. The treated eyes were followed up for 3 to 45 months, average 11.8 months.

The treatment was a success in 31 eyes (91 %), as the intraocular pressure (IOP) could be maintained under 25 mmHg with or without medication. Control of IOP level under 20 mmHg was achieved in 27 eyes (79 %).The pressure-lowering effect was most remarkable 12 months after treatment. The effect was positively cor-related with the degree of pigmentation in the trabecular meshwork. The reduction in 1OP was mOre remarkable in eyes with pre-treatment IOP levels of 30 mmHg or more. The facility of aqueous outflow (C) significantly improved after treatment (p<0.001).

We encountered no serious complications. Laser trabeculoplasty seemed to be of value in the treatment of capsular glaucoma.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(3) : 279-283, 1986