強膜内固定術で使用する7.0mmレンズと6.0mmレンズの臨床結果の比較

Comparison of the surgical results obtained using 7.0 mm and 6.0 mm lenses in flanged intrascleral IOL fixation

要約　目的：眼内レンズ強膜内固定術で使用する光学部径が7.0mmと6.0mmの眼内レンズによる臨床結果の比較検討を行う。

対象と方法：愛媛大学医学部附属病院で2017年8月〜2019年7月に，同一術者がエタニティNX70（参天製薬）とアバンシィ（興和）を用いたフランジ法による強膜内固定術を施行し3か月以上経過観察ができた31例31眼を対象とし，眼内レンズの偏位・傾斜・前房深度・角膜内皮細胞減少率・手術時間・術後合併症などについて後ろ向きに検討した。

結果：対象患者の内訳はNX70群14眼，アバンシィ群17眼。NX70群とアバンシィ群の比較において術後のレンズの傾斜はそれぞれ7.18±2.71°，5.79±2.05°，偏心は0.43±0.25mm，0.42±0.15mm，前房深度は4.54±0.54mm，4.37±0.47mmといずれも有意差はなかった。角膜内皮細胞減少率は，NX70群で9.14±18.5％，アバンシィ群で3.57±24.0％と有意差はなかったが，手術時間（強膜内固定に要する時間のみを抽出）はNX70群で593.6±116.0秒，アバンシィ群で469.4±118.6秒と有意な差があった（p＝0.007）。術後合併症としてNX70群で1眼，アバンシィ群で2眼の術後虹彩捕獲を認めた。また，支持部露出はNX70群で2眼，術後囊胞様黄斑浮腫はNX70群で1眼，アバンシィ群で2眼認められた。

結論：強膜内固定術において光学部径の異なる2種類の眼内レンズはいずれも固定位置は良好であり安全に手術を施行することができたが，一定の頻度で出現する術後合併症には注意が必要である。

Abstract　Purpose：To compare the clinical outcomes of two types of intraocular lenses（IOL）with diameters of 7.0 mm and 6.0 mm in flanged intrascleral IOL fixation.

Materials and methods：This retrospective study involved 31 patients who underwent flanged intrascleral IOL fixation performed by the same surgeon between August 2017 and July 2019 at Ehime University Hospital and who were followed for at least three months post operation. The IOL deviation and tilting, anterior chamber depth, percentage of corneal endothelium loss, operation times, and postoperative complications were analyzed.

Results：Of the 31 patients, 14 were included in Group A（NX70）and 17 were included in Group B（Avansee）. In Groups A and B, the mean tilts of the IOL were 7.18±2.71°and 5.79±2.05°, the mean amounts of deviation of the IOL were 0.43±0.25 mm and 0.42±0.15 mm, and the mean depths of the anterior chamber were 4.54±0.54 mm and 4.37±0.47 mm, respectively, with no statistically significant differences observed. Although the mean percentages of corneal endothelium loss in Group A and Group B were 9.14±18.5％ and 3.57±24.0％（p＝0.48）, the mean operation times were 593.6±116.0 s and 469.4±118.6 s, respectively with significant difference（p＝0.007）. Iris capture of the optic was observed in one eye in Group A and two eyes in Group B. Exposure of the haptic occurred in two eyes in Group A but did not occur in Group B. Postoperative cystoid macular edema was observed in one eye in Group A and two eyes in Group B.

Conclusions：In this study, good postoperative positioning of two types of IOL with different optic diameters was observed. However, clinicians need to consider the several complications that arise after flanged intrascleral IOL fixation.