抗血栓薬継続下で施行した線維柱帯切開術の検討

Evaluation of antithrombotic therapy in patients undergoing trabeculotomy

要約　目的：抗血栓薬服用継続下での線維柱帯切開術の手術成績と合併症を，抗血栓薬非服用例と比較検討した。

対象と方法：対象は初回手術として線維柱帯切開術を施行した111例で，男性68例，女性43例，年齢は平均69.0±14.2歳である。抗血栓薬服用症例（服用群）は抗血栓薬を休薬せずに線維柱帯切開術を施行した。抗血栓薬を服用していない患者（非服用群）と，術後眼圧，合併症を比較した。

結果：抗血栓薬服用群は23例（20.7％），非服用群は88例（79.3％）であった。術前眼圧および最終眼圧は，服用群23.3±5.4mmHg，14.9±3.6mmHg，非服用群26.5±8.4mmHg，16.1±5.4mmHgであり，両群の最終眼圧に有意差はなかった（p＝0.6）。術後1mm以上の前房出血が生じた症例は，服用群15例，非服用群40例で，両群に有意差はなかった（p＝0.2）。前房出血の消退期間は，服用群6.0±4.0日，非服用群4.0±3.0日で，服用群は前房出血消退までの期間が有意に長かった（p＝0.0154）。術後に前房出血が多く，前房洗浄が必要となった症例は，服用群3例（13.0％），非服用群1例（1.1％）で，服用群が有意に多かった（p＝0.0275）。

結論：抗血栓薬服用継続下に行う線維柱帯切開術は，非服用者に対する手術に比べて，前房出血消退に要する期間が長く，前房出血除去のために前房洗浄を要する頻度が増えるが，術後眼圧に有意差はなかった。

Abstract　Purpose：To evaluate the impact of antithrombotic drugs on the outcomes and complications in trabeculotomy for glaucoma.

Subjects and methods：We reviewed the data on 111 patients（111 eyes）who had undergone initial trabeculotomy. The series included 68 males and 43 females. Mean age was 69.0±14.2 years. We divided them into two groups：patients who received antithrombotic therapy before and during throughout surgery（medication group）and those who did not receive antithrombotic therapy（non-medication group）. The postoperative intraocular pressure（IOP）and complications were compared between the two groups.

Results：The medication group included 23 patients（20.7％）. The non-medication group included 88 patients（79.3％）. Preoperative and postoperative IOP averaged 23.3±5.4 mmHg and 14.9±3.6 mmHg in the medication group and 26.5±8.4 mmHg and 16.1±5.4 mmHg in the non-medication group. The differences were not significant（p＝0.6）. Anterior chamber hemorrhage of 1 mm or higher was found in 15 patients in the medication group and 40 patients in the non-medication group. The difference was not significant（p＝0.2）. Hyphema disappeared after 6.0±4.0 days in the medication group and 4.0±3.0 days in the non-medication group. The difference was significant（p＝0.0154）. Irrigation of the anterior chamber was required in 3 patients（13.0％）in the medication group and 1 patient（1.1％）in the non-medication group. The difference was significant（p＝0.0275）.

Conclusion：Patients who continued antithrombotic therapy at the time of trabeculotomy required more time before hyphema disappeared, and had increased need for irrigation of the anterior chamber. Postoperative IOP was not significantly different between the two groups.