眼内レンズ挿入術後炎症に対するインドメタシン点眼の功罪

Indomethacin eyedrops reduce inflammation after intraocular lens implantation

　眼内レンズ（IOL）挿入術後の合併症の一つであるフィブリン析出に対し，インドメタシン点眼（インドメロール^®）を使用し，その効果および副作用について検討を行った．症例は白内障患者432名（534眼）で，そのうちIOL挿入患者は246名（347眼）であった．IOL挿入例では，インドメタシン点眼使用前のフィブリン析出率69％に対し，使用後は6％と著減し，その有効性を認めた（p＜0.05）．しかし，filtering blebやwound leakageを起こした症例があり，創傷治癒遅延を惹起する可能性が示唆された．また，角膜上皮障害を起こした症例も4眼経験した．インドメタシン点眼中止と共に軽快したことより，その関与が疑われた．

We evaluated the value of topical indomethacin in reducing fibrinous reaction after intraocular lens (IOL) implantation surgery. Out of a consecutive series of 347 eyes who underwent IOL implantation surgery, 131 eyes were treated by conventional means, including instillation of betamethasone eye-drops after surgery. The second group of 216 eyeswere treated by instillation of indomethacin oph-thalmic solution, thrice daily, during the postoper-ative 1 week.

Fibrinous reaction developed in 69% of eyes not treated with indomethacin, and in 6% of eyes treated with the same. The difference was sig-nficant (p<0.05).

As untoward side effects, topical indomethacin seemed to delay the wound healing process. In the indomethacin treated group, filtering bleb devel-oped in 11 eyes, of which 4 required reconstructionsurgery to relieve wound leakage. Corneal epi-thelial defect developed in 4 patients, which im-proved after discontinuation of topical indometh-acin treatment.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(4) : 419-423, 1988