Ex-PRESS®を用いた濾過手術の術直後結果に影響を及ぼす因子の検討

Factors related to short-term outcome of filtrating surgery using Ex-PRESS® device

要約　緒言：Ex-PRESS^®を用いた濾過手術術後成績に及ぼす因子を検討する。対象と方法：当院でEx-PRESS^®挿入単独手術を施行した緑内障患者連続63例70眼を対象とし，レトロスペクティブに解析した。結果：病型は原発開放隅角緑内障47眼，ぶどう膜炎に伴う続発性緑内障7眼，血管新生緑内障6眼，落屑緑内障10眼。術前眼圧は20（18〜26）mmHg〔中央値（四分位数）〕，平均観察期間は3.0か月，術後最終受診時眼圧は9（7〜10）mmHgであった。術後一過性前房消失が4眼（5.7％）に認められた。眼圧12mmHg以下を成功と定義した場合，年齢補正後，眼内レンズ眼と落屑緑内障が有意な予後不良因子であった。結論：Ex-PRESS^®挿入単独手術の短期成績では合併症は少なかった。術後lowteenを目標眼圧値とした場合，眼内レンズ眼，落屑緑内障が予後不良因子として推定された。

Abstract.　Purpose：To evaluate the short-term efficacy and safety of filtering glaucoma surgery using the Ex-PRESS^® shunt device and investigate the factors affecting the prognosis in Japanese patients. Methods：Seventy eyes of 63 patients who underwent filtering glaucoma surgery using the Ex-PRESS^® shunt device were enrolled. Intraocular pressure（IOP）, adverse events, and visual outcomes were analyzed. Surgical success was defined as IOP of ≦12mmHg. Results：Forty-seven with primary open-angle glaucoma（OAG）, seven with secondary glaucoma（SG）caused by uveitis, six with neovascular glaucoma（NVG）, and ten with exfoliation glaucoma（ExG）were eligible for analysis. The mean age of patients was 65.7±13.0 years, and the mean follow-up period was 3.0 months. The median（interquartile range）preoperative and postoperative IOP values were 20（18-26）and 9（7-10）mmHg, respectively. Fifty-six eyes（80％）achieved complete success. Four eyes（5.7％）exhibited a temporary shallow or flat anterior chamber. Pseudophakic eyes and ExG were found to be significant predictors of poor outcome after adjusting for age and preoperative IOP. Conclusions：Ex-PRESS^® implantation surgery showed a low short-term complication rate. Pseudophakic eyes and ExG were more likely to result in surgical failure.