虹彩縫合を用いた瞳孔形成術におけるMcCannel法と眼内縫合法の比較検討

Comparison of intraocular iris suturing method and McCannel method for pupilloplasty

要約　目的：McCannel法（眼外法）と眼内虹彩縫合（眼内法）による瞳孔形成術の特徴と有用性を比較した。

対象と方法：不可逆性散瞳および瞳孔偏位に対し，虹彩縫合による瞳孔形成術を施行した17症例18眼を対象とした。術式は主に眼外法を，極大散瞳症例で多方向からの縫合が必要な場合には眼内法を選択し，眼外法12眼，眼内法3眼，両方法の併用3眼を行った。最長瞳孔径と最短瞳孔径を計測ソフトウェア（Image J）で測定し，平均値を瞳孔径と定義し術前後で比較した。瞳孔偏位量はIllustrator^®で画像的に角膜中心，瞳孔中心を同定し，2つの中心間の距離を瞳孔偏位量と定義し術前後で比較した。操作性の指標として，1か所当たりの虹彩の通針に要した時間を手術ビデオから測定し，眼外法と眼内法で比較した。

結果：瞳孔径は術前7.2±1.2mmから術後4.5±0.6mmへ，瞳孔偏位量は術前2.1±0.9mmから術後1.0±0.3mmと有意に減少した。通糸の所要時間は眼外法111.0±48.0秒，眼内法113.6±44.6秒で有意差はなかった。

結論：瞳孔形成術において，眼外法を第一選択とした本検討の結果は良好であり，眼外法が第一選択でよいと考えられた。各法の操作性は同等であると考えられた。多方向，特に垂直方向の縫合を要する症例には眼内法が有用である可能性がある。

Abstract　Purpose：To compare the validity of McCannel method（extraocular method）and intraocular iris suturing method（intraocular method）for pupilloplasty

Material and Methods：Pupilloplasty usinig iris suturing was performed for 17 patients（18 eyes）who have a fixed dilated pupil or pupil dislocation. The surgical method is mainly the extraocular method. If maximal mydriasis required suturing from multiple directions, the intraocular method was selected. The extraocular method was used in 12 eyes, the intraocular method 3 eyes, and a combination of both methods in 3 eyes. The longest pupil diameter and the shortest pupil diameter were measured with Image J, and the average value was defined as the pupil diameter and was compared before and after surgery. The amount of pupillary deviation was traced on the corneal margin and the pupillary border in Illustrator^®, and the center of each ring was defined as the corneal center and the pupil center. The distance between the two centers was defined as the amount of pupillary deviation and compared before and after surgery. The time required for threading was compared with the extraocular method and the intraocular method by measuring the time required to pass the iris at one location from the surgical video.

Results：Pupilloplasty were performed in 12 cases using Intraocular method in 3 cases, extraocular method in 12 cases, and both two methods in 3 cases. Pupil dilation decreased 7.2±1.2 mm to 4.5±0.6 mm. Pupil dislocation decreased 2.1±0.9 mm to 1.0±0.3 mm. The time required for iris iuturing was 111.0±48.0 second by extraocular method, 113.6±44.6 second by intraocular method for each. There was no significant difference in the time required for each of the two methods.

Conclusion：Intraocular method and extraocular method for pupilloplasty were both useful. Intraocular method was more useful in cases' that needed multiple suturing.