Combined mechanism glaucomaの治療について

Treatment of combined mechanism glaucoma

　虹彩切除後隅角が解放されたにもかかわらず眼圧コントロールの悪い閉塞隅角緑内症眼について検討した．このようなコントロール不良例は慢性閉塞隅角緑内障群に多く（60％），急性閉塞隅角緑内障群では少ない（20％）．また予防的虹彩切除の成績は良好で習熟した術者によるレーザー虹彩切除術はきわめて安全な方法といえる．慢性閉塞隅角緑内障眼においては隅角開放が確認されている場合でも，laser trabeculoplasty，trabeculotomy等の手術成績が不良であり原発性開放隅角緑内障より難治性であった．これらにおいては長期の隅角閉塞によって線維柱網が変性したと推測され，狭隅角眼に対する早期の積極的な予防虹彩切除の必要性が認識される．

We evaluated the course of 125 eyes with pro-dromal or manifest narrow angle glaucoma treated by laser iridotomy or by surgical iridectomy.

Eyes with prodromal narrow angle glaucomaresponded very favorably (98%) to either laser iridotomy (31 eyes) or surgical iridectomy (12 eyes). Control of intraocular pressure was achieved in 22 of 27 eyes with acute angle closure glaucoma when treated by laser iridotomy or surgical iridectomy. Persistence of acute attack seemed to be the major cause of failure as 4 out of the 5 eyes were treated by laser or surgery after more than 48 hours had elapsed after onset of attack.

Eyes with chronic angle closure glaucoma re-sponded less favorably to laser or surgery. Control of intraocular pressure below 20 mmHg, either with or without medication, was achieved in 16 of 40treated eyes (40%). The intraocular pressure remained the same in 12 eyes (30%). The intraocular pressure remained the same in 12 eyes (30%). Additional laser trabeculoplasty and/or trabeculotomy was generally poor in these eyes. Longestanding chamber angle closure in chronic angle closure glaucoma would result in degenera-tion of trabecular meshwork. Early diagnosis andprophylactic treatment is therefore essential in preventing evolution of cases of chronic angle clo-sure glaucoma which respond poorly to treatment.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(4) : 293-296, 1987