広島大学病院におけるバルベルト緑内障インプラントの術後成績

Outcome of Baerveldt glaucoma implant at Hiroshima University Hospital

要約　目的：広島大学病院でのバルベルト緑内障インプラント（BGI）の術後成績の報告。

対象と方法：過去28か月間にBGI挿入手術を行った53例56眼を対象とした。すべて日本人で，男性33眼，女性23眼であり，年齢は1〜87歳，平均53歳である。内訳は，血管新生緑内障17眼，続発緑内障16眼，原発開放隅角緑内障6眼である。緑内障手術の既往は2.1±2.0回であり，眼圧，点眼スコア，角膜内皮細胞，合併症について，平均12.1か月の経過を観察した。眼圧が5mmHg以下，22mmHg以上，眼圧が術前の20％以下に低下，または手術を必要とする合併症が生じた場合を死亡とし，それ以外を生存とした。

結果：眼圧の平均値は，術前30.2±9.3mmHg，術後12か月11.8±3.9mmHgで，有意に下降した。点眼スコアは術前3.1±0.9，術後1.2±1.3で，1年生存率は76.8％であった。BGI 250を用いた40眼と，BGI 350を用いた16眼とで成績の差はなかった。21眼で測定した角膜内皮細胞数は，術後6か月で平均6.3％減少した。

結論：難治性緑内障に対するBGI挿入術は，1年後に56眼中43眼（77％）で有効であった。この成績は，海外での報告とほぼ同等である。

Abstract　Purpose: To report the outcome following insertion of Baeveldt glaucoma implant（BGI）at Hiroshima University Hospital.

Cases and Method: This study was made on consecutive series of 56 eyes of 53 cases who received BGI during the past 28 months. All were Japanese citizens and comprised 33 male and 23 female eyes. The age ranged from one to 87 years, average 53 years. Neovascular glaucoma was present in 17 eyes, secondary glaucoma in 16 eyes, and primary open-angle glaucoma in 6 eyes. Glaucoma surgery had been performed at an average of 2.1±2.0 times. Cases were followed up for an average of 12.1 months regarding intraocular pressure（IOP）, medication score, corneal endothelial cells, and complications. The outcome was regarded as failure when IOP remained below 5 mmHg or over 22 mmHg, or complications developed needing surgery.

Results: IOP averaged 30.2±9.3 mmHg before and 11.8±3.9 mmHg 12 months after surgery. The difference was significant（p＜0.01）. Surgery was success in 43 eyes（77％）one year after surgery. The medication score averaged 3.1±0.9 before and 1.2±1.3 12 months after surgery. There was no difference between 40 eyes that received BGI 250 and 16 eyes that received BGI 350. Corneal endothelial cells decreased by an average of 6.3％ 6 months after surgery.

Conclusion: BGI was effective in 43 out of 56 Japanese eyes（77％）one year after surgery.