レーザー虹彩切除による角膜障害について

Corneal damage after laser iridectomy

　92名133眼の狭隅角眼（AACG 25眼，CACG 60眼，予防手術48眼）においてアルゴンレーザーによる虹彩切除術（ALI）を施行し，129眼97％において永続する穿孔を得た．CACGと予防手術後の一過性眼圧上昇（5mmHg以上）は108眼中30眼（28％）にみられ，corneal burnは133眼中15眼11％にみられた．術後の角膜内皮障害は軽度でhexagonalityが一過性に13.6％，細胞密度も一過性に5.9％低下したが，いずれも統計学的に有意な減少ではなかった．偏平率と変動係数にも有意の差がなく代償不全をおこすような重篤な合併症は認められなかった．穿孔不成功例は4眼でAACG眼に8％と多く，患者の固視不良，虹彩面の滲出物，浅前房，角膜混濁が主な原因であった．

We treated 133 eyes, 92 patients, by argon laser iridectomy. The series included acute angle closure glaucoma (AACG) 25 eyes, chronic angle closure glaucoma (CACG) 60 eyes, and prodromal angle closure glaucoma 48 eyes. Permanent opening in the iris was obtained in 129 eyes (97%).

Transient elevation of intraocular pressure occurred in 30 eyes (28%) of 108 CACG and pro-dromal glaucoma eyes. Corneal burn was noted in 15 out of the 133 eyes (11%). The damage to thecorneal endothelium was mild. When examined by specular microscopy, hexagonality was reduced by 13.6%, and the cell density by 5.9% at 1 week after treatment. These reductions were statistically not significant.

The skewness and variance indices of the cornea were not affected by the treatment. We observed no instance of endothelial decompensation throught the present series.

The iris could not be perforated in 4 eyes : AACG 2 eyes (8%) and CACG 2 eyes (3%). The failure was mainly due to instability of the eye or the patient, shallow anterior chamber, hazy cornea, or exudation on the iris surface after repeated laser application.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(5) : 580-590, 1988