Trabeculectomy術後早期よりの血液前房内逆流に関する経時観察

Blood reflux into anterior chamber after trabeculectomy in open-angle glaucoma. A long term observation

　Trabeculectomyを施行した開放隅角緑内障31眼に対し，強膜圧迫隅角検査法を用いて，切除部隅角を術後早期から経時的に観察した．

　術後1週目より1週毎の観察を試みた10眼では，M₁H₁型隅角6眼中5眼において術後1-2週目に，Schlemm管断端部から血液逆流を見た．しかし，その部分に後に全例，PASを形成した．残りの1眼では術後4週目に初めて逆流出現したが，周辺部虹彩前癒着（PAS）は生じなかった．そこで，以降の症例に対しては術後1カ月目より観察を行った．術後12カ月間の観察期間において14眼の計23カ所から逆流を見た．それ以降では新しい逆流出現はみられなかった．一方，23カ所中10カ所で経過中に逆流が消失したが，その内，9カ所は，この12カ月間の観察期間内であった．以上の事から，人眼におけるtrabeculectomy隅角部に開口するSchlemm管を含む血管の活発な修復機転は，約1年で終了する事が示唆された．

We performed compression gonioscopy by applying pressure with the edge of Goldmann 2-mirror goniolens after variable periods following trabeculectomy. We evaluated 31 eyes with open-angle glaucoma, including 16 primary and 15 secondary ones, with this method.

In the initial series of 10 eyes, compression gonio-scopy was started from 7 postoperative day on. In 5 out 6 eyes, blood reflux could be induced from the cut end of Schlemm's canal within 1 to 2 weeks after surgery. Peripheral anterior synechia (PAS) resulted at the site of trabeculectomy in these eyes.

Compression gonioscopy was then performed after 1 month or later in the second series of 21 eyes.Blood reflux could be induced in 14 eyes from 23 surgical sites during the observation period of 12 postoperative months. After this period, no new blood refluxes could be induced. Blood reflux disappeared in 10 out of the 21 sites. This disappearance occurred within 12 postopera-tive months in 9 out of the 10 sites. This finding seemed to suggest that active reparative processes of the vascu-lar openings at the trabeculectomized site would cease about one year after surgery.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(7) : 746-748, 1986