iStent®併用白内障手術の術後成績

Postoperative outcomes of cataract surgery with iStent®

要約　目的：iStent^®併用白内障手術の術後成績と有害事象について検討を行うこと。

対象と方法：2018年4月〜2020年12月の間に，広島大学病院および広島アイクリニックでiStent^®併用白内障手術を行った30例30眼を対象とした。診療録から後ろ向きに術前と術後12か月までの眼圧，点眼スコアを比較した。術後12か月の20％以上の眼圧下降達成率についても検討した。

結果：病型は（広義）原発開放隅角緑内障が27眼，落屑緑内障が3眼であった。12か月後，眼圧は術前13.2±3.0mmHgから11.3±2.4mmHgまで下降したが有意差はなかった（p＝0.0884）。点眼スコアは術前1.8±1.0から0.3±0.6と有意に減少した（p＜0.001）。20％の眼圧下降は40％であり，有害事象として術翌日に軽度前房出血が5眼で生じたが，保存的加療で1〜2週後に自然消失した。

結論：iStent^®併用白内障手術で1か月以降眼圧は軽度下降し，点眼スコアは術後すべての観察期間で有意に減少した。iStent^®は有害事象の頻度が低く点眼スコアの減少に有用である。

Abstract　Purpose：To investigate the postoperative outcomes and adverse events of cataract surgery with iStent^®.

Subjects and Methods：In the present study, we included thirty eyes from thirty patients who underwent cataract surgery with iStent^® at Hiroshima University Hospital and Hiroshima Eye Clinic between April 2018 and December 2020. We examined retrospectively from the medical records, and compared between preoperative and postoperative 12 months of intraocular pressure and number of medications. Also we examined archive ratio of reduction in intraocular pressure of 20％ from preoperation at 12 months postoperative.

Results：Twenty-seven eyes showed primary open angle glaucoma and three eyes showed exfoliation glaucoma. Intraocular pressure was reduced to 11.3±2.4 mmHg at 12 months post operation from that observed at the preoperative stage 13.2±3.0 mmHg, but this reduction was not significant（p＝0.0884）. The number of medications was reduced to 0.3±0.6 at 12 months post operation from 1.8±1.0 at the preoperative stage, and this reduction was significant（p＜0.001）. A 20％ reduction in intraocular pressure from the preoperative stage was achieved in 40％ of eyes；and five eyes showed adverse events of mild hyphema at 1 day post operation and these adverse events disappeared with conservative treatment from 1 week to 2 weeks post operation.

Conclusions：Intraocular pressure was reducted slightly 1 month after the cataract surgery with iStent^®, and the number of medications was reduced significantly 12 months post the operation. Thus, iStent^® is useful in reducing the number of medications required and lowering the risks of adverse events.