眼内灌流液と超音波水晶体乳化術中の気泡発生について

Intraocular irrigating solution influences bubble formation during ultrasonic phacoemulsification surgery

　ケルマン超音波水晶体乳化装置を用い，豚眼前房内を各種眼内灌流液で置換し，灌流液組成成分が超音波発振時の前房内気泡発生に与える影響を検討した．炭酸ガス重炭酸イオン系を全く含まないBSS （balanced salt solution），乳酸リンゲルは，それらを含むGBR （glutathion bicar-bonate ringer），S-MA2等に比べ明らかに気泡発生が少なかった．重炭酸イオンを含み，炭酸ガス平衡を行っていない灌流液は，炭酸ガス平衡を行っている灌流液に比べ気泡発生が少なく，家兎眼を用いた角膜内皮灌流実験では，両灌流液間の角膜膨潤速度に有意の差を認めなかった．高分子デキストランを含む溶液は含まない溶液に比べ気泡発生が多かった．超音波水晶体乳化術には，グルコースや重炭酸イオンを含み炭酸ガス平衡をしていない灌流液が手術操作に障害となる前房内気泡発生が少なく実用に適すると思われた．

We irrigated the anterior chamber of enucleated pig eyes using Kelman phacoemulsifier 8000 V with various intraocular irrigating solutions. Air bubble formation during application of ultrasonic vibration for 20 seconds was recorded on videotape. Therecorded findings were evaluated by 10 senior oph-thalmologists by a single-blind manner and air bubble formation was graded into 4 grades.

The solutions containing bicarbonate and equili-brated with CO₂ (S-MA2, glutathione-bicarbonate-ringer and BSS plus) and that containing dextran in addition (BOS) showed air bubble formation rang-ing in grade between 2.4 and 3.4 (N =3). Lactated ringer solution added with 25 mM bicarbonate and 5.55 mM glucose but not equilibrated with CO₂ shoed significantly lesser air bubble formation rang-ing in grade between 0.5 and 1.5 (p < 0.025). The solutions containing neither bicarbonate nor CO, also showed little air bubble formation. In another experiment, we perfused the epith-elium of paird rabbit corneas in vitro using a dual chambered specular microscope for 4 hours. One of the pair was perfused with glutathione-bicarbonate -ringer (GBR) equilibrated by CO, and the other with GBR without equilibration. The rate of cor-neal swelling was 6.9+2.3 for the former and 5.0+ 2.0 for the latter (pl/hr, N = 4). There was no signif-icant differences between the two groups. It is concluded that the solutions either containing bicarbonate equilibrated with CO, or dextran arenot suitable for phacoemulsification because air bubble formation interferes with surgical manipula-tions in the anterior chamber. Solutions containing bicarbonate and glucose but not equilibrated with CO, may be the choice for phacoemulsification.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(5) : 535-540, 1987