Suture trabeculotomy眼内法における全周切開と半周切開の比較

Comparison of the results of suture trabeculotomy ab interno between total incision and half incision

要約　目的：Suture trabeculotomy眼内法（s-lot）の全周切開と半周切開の術後成績について比較検討する。

対象と方法：2018年2月〜2020年1月にs-lotを施行し，切開範囲が300°以上の112例151眼を全周切開群，2020年2月〜2021年3月にs-lotを施行し，切開範囲が120°以上240°以下の105例130眼を半周切開群とした。症例の内訳は，全周切開群/半周切開群でそれぞれ広義原発開放隅角緑内障88/84眼，落屑緑内障41/38眼，原発閉塞隅角緑内障14/3眼，その他8/5眼であった。これら2群について術後眼圧，累積生存率，薬剤スコア，合併症について後ろ向きに検討した。累積生存率は，眼圧が5mmHg以上15mmHg以下かつ20％以上の眼圧下降の達成および緑内障手術追加なしを成功基準と定義した。

結果：術後12か月の累積生存率は全周切開群で83.5％，半周切開群で66.5％と全周切開群で有意に高かった。術12か月後の平均眼圧は全周切開群で11.7±2.6mmHg，半周切開群で12.9±2.3mmHgと全周切開群で有意に低かった。術12か月後の薬剤スコアは全周切開群で2.4±1.3，半周切開群で2.0±1.5と有意差はなかった。術後合併症は，前房出血が全周切開群，半周切開群でそれぞれ62.9％，39.5％と全周切開群で有意に多く，一過性眼圧上昇は28.5％，29.2％と有意差がなかった。

結論：s-lotは全周切開群で有意に眼圧が下降したが，合併症も全周切開群で有意に多かった。

Abstract　Purpose：To compare the results of suture trabeculotomy ab interno（s-lot）between total incision and half incision.

Methods：This retrospective study included 151 eyes of 112 cases that underwent total incision of s-lot, and 130 eyes of 105 cases of half incision. The intraocular pressure（IOP）, cumulative survival rate, number of glaucoma medications and complication were examined in this study. Surgery was judged as success when IOP was maintained between 5 and 15 mmHg and when≧20％ IOL reduction was achieved.

Results：The cumulative survival rate at 12 months after surgery was 83.5％ in the total incision group and 66.5％ in the half incision group. It was significantly higher in the total incision group. The mean IOP at 12 months after surgery was 11.7±2.6 mmHg in the total incision group and 12.9±2.3 mmHg in the half incision group. It was significantly lower in the total incision group. The number of glaucoma medications at 12 months after surgery was 2.4±1.3 in the total incision group and 2.0±1.5 in the half incision group. However there was no significant difference. Postoperative hyphema occurred in 62.9％ of the cases in the total incision group and in 39.5％ of the cases in the half incision group. Transient IOP increase occurred in 28.5％ of the cases in the total incision group and in 29.2％ of the cases in the half incision group. There was no significant difference.

Conclusion：The total incision of s-lot was regarded as a more effective procedure than the half incision of s-lot, but complications occurred more frequently in the total incision of s-lot.