前眼部光干渉断層計を用いた線維柱帯切除術後に生じる毛様体脈絡膜剝離の検討

Evaluation of ciliochoroidal detachment after trabeculectomy by anterior-segment optical coherence tomography

要約　目的：緑内障に対する線維柱帯切除術後の毛様体脈絡膜剝離に関係する因子の報告。

対象と方法：この前向き研究は，過去20が月間に東京大学医学部附属病院で線維柱帯切除術を行った128例161眼のうち，十分な所見が得られた91例96眼を対象とした。内訳は，広義の原発開放隅角緑内障性58眼，原発性閉塞隅角緑内障5眼，落屑緑内障14眼，続発緑内障19眼である。毛様体脈絡膜剝離の有無は，手術の1か月後に前眼部光干渉断層計で評価し，年齢，眼圧，術後合併症などとの関連を検討した。

結果：毛様体脈絡膜剝離は19例19眼に生じ，その有無と，術前術後の眼圧との有意な相関はなかった。術後1か月以内に処置を必要とした浅前房の存在のみが，毛様体脈絡膜剝離の発症と有意に関連していた（オッズ比6.0，p＝0.04）。

結論：線維柱帯切除術後の術後早期に生じる毛様体脈絡膜剝離には，術後の浅前房が関連していた。

Abstract　Purpose：To report factors related to ciliochoroidal detachment after trabeculectomy by anterior-segment optical coherence tomography.

Cases：This prospective study was made on 161 eyes of 128 cases who received trabeculectomy during the past 20 months. A total of 96 eyes of 91 cases were analyzed that fulfilled due requirements for evaluation. The series comprised primary open-angle glaucoma 58 eyes, primary angle-closure glaucoma 5 eyes, capsular glaucoma 14 eyes, and secondary glaucoma 19 eyes. Presence of ciliochoroidal detachment was determined by anterior-segment optical coherence tomography（OCT）one month after surgery.

Results：Ciliochoroidal detachment developed in 19 eyes of 19 cases after surgery. Its incidence was not significantly correlated either with intraocular pressure before or after surgery, age of the patient, or type of glaucoma. It was significantly correlated with postoperative shallow anterior chamber that needed treatment within one month of surgery（p＝0.04）.

Conclusion：Incidence of ciliochoroidal detachment after trabeculectomy was significantly correlated with shallow anterior chamber within one month of surgery.