深層強膜弁形状を工夫したトラベクレクトミーの術後早期成績

Short-term outcome of trabeculectomy with modified second flap

要約　目的：線維柱帯切除術の標準方式と，深層強膜弁の形状を改変した変法の，術後早期成績と合併症の報告。

対象と方法：過去58か月間に線維柱帯切除術またはその変法を行った原発開放隅角緑内障と落屑緑内障29例33眼を対象とした。術後3か月までの眼圧，視力，屈折，合併症を診療録の記述に基づいて検索した。

結果：術前の眼圧は，標準手術群28.3±15.1mmHg，変法27.6±8.2mmHgであった。術後の眼圧は，術後1週，1か月，3か月とも両群で有意に下降した（p＜0.01）。術後の眼圧，視力，屈折については，両群間に有意差はなかった。術後早期の低眼圧と術後浅前房の頻度は，標準群よりも変法群で有意に少なかった。

結論：原発開放隅角緑内障と落屑緑内障に対して行った線維柱帯切除術の標準方式と，深層強膜弁の形状を改変した変法の3か月間の成績は，眼圧，視力，屈折については有意差がなく，合併症は後者が少なかった。

Abstract　Purpose: To report the short-term outcome of trabeculectomy after standard procedure and modified second flap.

Cases and Method: This retrospective study was made on 33 eyes of 29 patients who received trabeculectomy after standard procedure or modified second flap for primary open-angle glaucoma or capsular glaucoma in the past 58 months. Cases were followed up regarding intraocular pressure（IOP）, visual acuity, refraction and complications for 3 months after surgery.

Results: IOP before surgery averaged 28.3±15.1 mmHg in standard group and 27.6±8.2 mmHg in the modified group. IOP after surgery significantly decreased in both groups up to 3 months（p＜0.01）. There was no difference between the two groups regarding IOP, visual acuity, or refraction up to 3 months after surgery. Incidence of early ocular hypotony and shallow anterior chamber was significantly lower in the group that received trabeculectomy with modified second flap.

Conclusion: Trabeculectomy after standard procedure and modified second flap showed the same outcome regarding IOP, visual acuity or refraction up to 3 months. The latter procedure showed significantly lesser incidence of complications.