新生血管緑内障に対するレーザー隅角光凝固術の試み

Effect of laser goniophotocoagulation on neovascular glaucoma

　眼圧コントロール困難な新生血管緑内障18例21眼に対しレーザー隅角光凝固術（GPC）を施行した。

　その結果21眼中13眼で，1眼は単独，12眼では薬物療法を併用して眼圧21mmHg以下となり新生血管の消退を認めた。原因別の治療効果は，糖尿病性網膜症10眼中8眼，虹彩炎4眼中4眼と良好であったが，網膜中心静脈閉塞症5眼中1眼，原因不明2眼中0眼と成績は不良であった。網膜光凝固術または網膜冷凍凝固術との併用については，汎網膜光凝固の途中にGPCを施行したものの成績が，4眼中4眼と最も良好であった。初回治療としてGPCを施行したものに3眼中1眼，GPC単独で6眼中4眼に有効な症例がみられた。

　合併症としては，照射後の隅角周辺前癒着形成と繰り返し治療を要する点が問題であった。

We applied argon laser goniophotocoagulation to 21 eyes, 18 patients, with neovascular glaucoma of variable causes. In all the eyes, the intraocular pressure was uncontrolled with maximum tolerated medical therapy. The follow-up period after appli-cation of laser therapy averaged 8.2 months.

Goniophotocoagulation was judged as success in 13 of 21 treated eyes (62%). In these 13 eyes, the chamber angle neovascularization disappeared and the intraocular pressure could be maintained below 21 mmHg with or without supplementary medical treatment. The rate of success dffered in regard to the underlying disease. Goniophotocoagulation wasa success in 8 of 10 eyes with diabetic retinopathy, 1 of 5 eyes with central retinal vein occlusion, 4 of 4 eyes with uveitis and 0 of 2 eyes of miscellaneous origin. Retinal photocoagulation or cryotherapy, when performed either before or after gonio-photocoagulation, was a contributary factor for better pressure-lowering effects.

The findings indicate that goniophotocoagula-tion is of value in the treatment of neovascular glaucoma, either performed with or without retinal photocoagulation or cryotherapy. The method would need further refinement regarding posttreat-ment peripheral anterior synechia and frequency of laser sessions.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(11) : 1245-1248, 1987