トラベクトーム手術後に術前眼圧下降薬を継続した場合の眼圧経過

Intraocular pressure following trabeculotome surgery with continuous medication

要約　目的：緑内障に対するトラベクロトーム手術後に，薬物治療を継続したときの眼圧の経過の報告。対象と方法：過去3年間にトラベクロトーム手術を行った緑内障34例46眼を対象とした。平均年齢は76歳で，42眼が原発開放隅角緑内障，4眼が落屑緑内障であった。41眼には白内障の同時手術を行った。平均9か月の術後経過を追った。術前と術後を通じ，同じ点眼加療を行った。結果：眼圧の平均値は，術前21.1±4.2mmHg，術後6か月14.9±3.8mmHgで，有意に下降した（p＜0.001）。術後の前房出血が全例にあった。術後1週間以内に30mmHg以上への眼圧上昇が6眼にあり，いずれも炭酸脱水酵素阻害薬の内服で，2日後に眼圧が低下した。4眼で術後3か月以内に追加手術が行われた。結論：薬物治療を継続した状態で，緑内障に対して行われたトラベクロトーム手術の6か月後に，眼圧が有意に下降した。一過性の前房出血が46眼の全例にあり，6眼に一過性の眼圧上昇があった。

Abstract.　Purpose：To report changes in intraocular pressure（IOP）following trabeculotome surgery with continuous medication. Cases and Method：This study was made on 46 eyes of 34 cases who received trabeculotome surgery in the past 3 years. The age averaged 76 years. Primary open-angle glaucoma was present in 42 eyes. Capsular glaucoma was present in 4 eyes. Simultaneous cataract surgery was made on 41 eyes. Cases were followed up for an average of 9 months after surgery. All the cases received the same medication before and after surgery. Findings：IOP averaged 21.1±4.2 mmHg before and 14.9±3.8 mmHg 6 months after surgery. The difference was significant（p＜0.001）. All the eyes showed transient hyphema after surgery. IOP rose to 30 mmHg or more within one week of surgery in 6 eyes. IOP was controlled within two days of systemic treatment with carbonic anhydrase inhibitor. Additional surgery was performed in 4 eyes within 3 months of trabeculotome surgery. Conclusion：IOP decreased for 6 months after trabeculotome surgery under continuous medication. All the 46 eyes showed transient hyphema after surgery. Six eyes showed transient rise of IOP after surgery.