インドメタシン点眼の術後前房蛋白濃度と細胞数への影響

Effects of topical indomethacin to the protein and cell count in the aqueous after intraocular lens implantation

　インドメタシン点眼が術後前房蛋白濃度と細胞数，後期フィブリン発現率に及ぼす影響を検討した。対象は老人性白内障で計画的嚢外法により後房眼内レンズを挿入，術後インドメタシンを点眼した30例30眼（点眼群）で，術後非点眼の49例49眼（対象群）と比較した。インドメタシンは術翌日から7日間まで0.5％油性点眼液を1日3回点眼し，フレアセルメーターで前房蛋白濃度と細胞数を測定した。点眼群の前房蛋白濃度は術翌日中央値610mg／dl （ウシアルブミン換算，以下同様）と高値であったが2日目以降急速に低下した。3日目以降は全例290mg／dl以下となり，術後2日目以降対照群と有意の差を認めた（P＜0.01）。細胞数も術後順調に低下したが両群間に前房蛋白濃度ほど明確な差はなかった。後期フィブリンは全く認めず，対照群の発現率31％と有意の差を認めた（P＜0.01）。以上よりインドメタシン点眼は術後早期から良好な血液房水柵修復をもたらしたフィブリン発現を抑制すると考えた。

We evaluated the effects of topical indomethacin on the protein content and cell count in the aqueous following planned extracapsular cataract extrac-tion with posterior chamber lens implantation (PECCE/PCL). We used a newly devised flare-cell meter in the study. A series of 30 eyes received 0.5% indomethacin in oil 3 times daily postoperatively. Another series of 49 eyes were treated without indomethacin. We measured protein content and cell count in the aqueous daily up to 7th postoper-ative day.

In the treated group, the median value of protein content was 610 mg/dl on the first day, 190 on the second and less than 130 from the 3rd day on. There was a significantly difference in the protein content from the second day on between the two groups (p<0.01).

The cell count in the aqueous ran a similar couse in treated and non-treated eyes up to 3rd postoper-ative day. There was a significant decrease in the cell count in the treated eye as compaed with the non-treated group from the 4th postoperative day (p<0.05).

These findings seemed to explain the earlier observation that topical indomethacin suppresses fibrin exudate on the surface of intraocular lens. It appeared that topical indomethacin prevents break-down of blood-aqueous barrier by prostaglandins during the early postoperative phase.