Anterior chamber tube shunt to an encircling bandによる難治性緑内障の治療成績

Anterior chamber tube shunt to an encircling band in the treatment of refractory glaucomas

　新生血管緑内障を含む種々の減圧手術に抵抗する難治性緑内障29例31眼にanteriorchamber tube shunt to an encircling band（ACTSEB）を施行し次の様な結果を得た．

（1）術後21mmHg以下にコントロールされた症例は新生血管緑内障（NVG）63.6％，原発開放隅角緑内障（POAG）87.5％，原発閉塞隅角緑内障（PACG）100％，続発緑内障（SG）66.6％，計73.8％であった．

（2）術後の平均眼圧下降幅はNVG 31.4mmHg, POAG 20.5mmHg, PACG 32.7mmHg，SG 19.4mmHg，計25.2mmHgで統計学的に有意な眼圧下降がみられた（p＜0.01）．

（3） NVGに対するACTSEB以外の術式では統計学的に有意な眼圧下降はみられず，ACTSEBはこれらの術式すべてに対し統計学的に有意に眼圧は下降していた（p＜0.01）．

（4）前眼部螢光所見，動物実験から房水はチューブ内を通ってband腔へ導かれることは証明されたがその先の経路は明らかにできなかった．

　以下より本法は種々の難治性緑内障に有効であることが明らかにされたが，更により安全確実な手術法とするため研究が必要である．

We treated 31 eyes with refractory glaucomas by implanting anterior chamber tube shunt to an encir-cling band (ACTSEB) during the foregoing 32 months. The cases included 11 eyes with neovas-cular glaucoma (NVG), 8 eyes with primary open angle glaucoma (POAG), 3 eyes with primary angle closure glaucoma (PACG) and 9 eyes with various secondary glaucomas (SG). The followup period ranged from 4 to 31 months. The intraocular pres-sure (IOP) prior to surgery averaged, with maxi-mum medication, 54.5±8.8mmHg in NVG, 42.1±12.2 in POAG, 46.7±7.6 4s PACG, and 40.9±4.7 in SG. The IOP after surgery averaged 23.2±8.2 mmHg in NVG, 21.6±11.3 in POAG, 14.0±1.7 in PACG and 22.0±6.2 in SG. The IOP drop was signif-icant for each group (p<0.01). Control of IOP below 21mmHg was attained in 64% of eyes with NVG, 88% with POAG, 100 with PACG and 67% with 67%.

Above findings indicate that ACTSEB is an effi-cient therapeutic modality for refractory glaucomas. Fluorescein angiographic and experi-mental evidences showed the aqueous humor to flow out through the implanted tube into the cavity of the encircling band. Little is as yet known as to the outflow route from the cavity.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(4) : 297-301, 1987