Ab interno trabeculectomyの手術成績に影響する因子の検討

Factors associated with the outcome of ab interno trabeculectomy

要約　目的：トラベクトーム^®を用いた線維柱帯切除術の成績に影響する因子の報告。

対象と方法：過去18か月間に線維柱帯切除術を行い，6か月以上の経過が観察できた56例68眼を対象とした。男性41眼，女性27眼で，平均年齢は71歳である。緑内障の内訳は原発開放隅角緑内障17眼，落屑緑内障48眼，続発緑内障3眼である。手術成績に影響する因子として，年齢，性別，中心角膜厚，術前眼圧，緑内障の病型，術式，緑内障手術の既往を検討した。

結果：平均眼圧は術前23.4±6.8mmHgから6か月後13.7±3.8mmHgに有意に下降した（p＜0.001）。6か月生存率は75.0％であった。眼圧下降率は，白内障同時手術を行った症例で有意に高くなり（p＝0.041），中心角膜厚と負の相関を示した（p＝0.012）。

結論：トラベクトーム^®を用いた線維柱帯切除術の6か月後の成績は，白内障同時手術を行ったときと，中心角膜厚が薄い症例で有意に良好であった。

Abstract　Purpose: To report factors that may influence the outcome of ab interno trabeculectomy using Trabecutome^®

Cases and Method: This retropective study was made on 68 eyes of 56 patients who received surgery in the past 18 months and who were followed up for 6 months or longer. The series comprised 41 males and 27 females. The age averaged 71 months. The series included 17 eyes of primary open-angle glaucoma, 48 eyes with capsular glaucoma, and 3 eyes with secondary glaucoma. As potential factors that affect the outcome of surgery, we evaluated age, sex, central corneal thickness, intraocular pressure（IOP） before surgery, type of glaucoma, history of glaucoma surgery, and type of surgery.

Results: IOP averaged 23.4±6.8 mmHg before surgery and 13.7±3.8 mmHg 6 months after surgery. The difference was significant（p＜0.001）．Surgery was evaluated as success in 75.0％ after 6 months Rate of IOP decrease was significantly higher in eyes receiving simultaneous cataract surgery（p＝0.041）, and was negatively correlated with the central corneal thickness.

Conclusion: Glaucoma surgery using Trabecutome^® was more effective in eyes with lesser central corneal thickness and in eyes receiving simultaneous cataract surgery.