原発性閉塞隅角緑内障における周辺虹彩切除とレーザー虹彩切開の比較

Peripheral iridectomy versus argon laser iridotomy in treating primary angle-closure glaucoma

　周辺虹彩切除術もしくはアルゴンレーザー虹彩切開術を施行した後，長期経過をみた原発性閉塞隅角緑内障（PACG）80例109眼について両術式の手術成績を比較し，以下の結論を得た．

　①両術式間には術後眼圧調整成績に差はなく，どちらも術前PAS ratioが50％未満あるいは術前C値が0.20以上の例では術後の眼圧調整は極めて良好であった．術前PAS ratioが75％以上あるいは術前C値が0.10未満であった例は緑内障治療薬の点眼のみでは術後眼圧の調整は困難であった．

　②術前後でのPAS ratioやC値の変化については両術式間に差はなかった．

　③いずれの術式にも重篤な合併症はなく，術後視力経過にも両術式間に差はなかった．

　以上のことから両術式の効果は同等と考えられ，PACGの治療には，手技の簡便さと安全性からみてアルゴンレーザー虹彩切開術を第1選択としてよいことを確認した．

We evaluated the long-term results of peripheral iridectomy and argon laser iridotomy in eyes with primary angle-closure glaucoma. Peripheral iridectomy (PI) was performed in 56 eyes of 42 patients, and argon laser iridotomy (ALI) in 53 eyes of 38 patients. All the cases were followed up for 12 months or more.

Postoperatively, intraocular pressure (IOP) was controlled under 21 mmHg with or without medication in 80% and 79% of eyes after PI and ALI respectively.Regardless of the therapeutic modality, IOP was suc-cessfully controlled in eyes with preoperative peripheral anterior synechia (PAS) less than 50% of the angle circumference and preoperative outflow facility of 0.20 or more. Conversely, IOP was poorly controlled in eyes with preoperative PAS extending over 75% and with preoperative outflow facility less than 0.10 with topical medications.

There was no difference between PI and ALI as to thepostoperatively induced changes in the extent of PAS and outflow facility. We encountered no serious compli-cations during and after treatment throughout our series. Due to progression of cataract, visual acuity loss of more than 2 lines in acuity chart occurred in 32% and 29% of eyes after PI and ALI respectively.

While both procedures are safe and effective means of treatment for primary angle-closure glaucoma, we advocate ALI as a primary procedure because of its simplicity and ease of application.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(1) : 27-32, 1987