広義原発開放隅角緑内障における治療別の眼圧変化と角膜ヒステリシス変化

Change of corneal hysteresis by treatment method for primary open-angle glaucoma

要約　目的：広義原発開放隅角緑内障（POAG）で点眼・レーザー・手術など治療の種類により角膜ヒステリシス（CH）の変化に違いがあるか検討した。

対象と方法：対象は2016年9月〜2021年6月の間に当院にて眼圧下降治療を施行した広義POAG患者。治療は点眼，選択的レーザー線維柱帯形成術（SLT），iStent挿入術＋水晶体再建術（iStent），Ex-PRESS濾過手術（Ex-PRESS）から選択した。各群の治療前・治療6か月後の眼圧とCHを測定し，眼圧とCHの変化量，変化率，変化率の相関を解析した。

結果：対象は152例152眼（点眼39眼，SLT 40眼，iStent 31眼，Ex-PRESS 42眼）。4群比較にて眼圧変化量，CH変化量はそれぞれ有意差（p＜0.001）を認め，いずれもEx-PRESS群で最も変化量が大きかった。Ex-PRESS群・点眼群で眼圧変化率とCH変化率はそれぞれ有意な負の相関を認めた（p＝0.037，p＝0.002）。

結論：広義POAGに4種の緑内障治療を施行した結果，眼圧下降やCH増加は治療の種類により異なり，特にEx-PRESS濾過手術でCHがより増加する可能性がある。

Abstract　Purpose：We investigated whether there were differences in changes in corneal hysteresis based on treatment method, such as topical prostaglandin（PGA）therapy, laser therapy and surgery, in patients with primary open-angle glaucoma（POAG）.

Patients and Methods：The participants were POAG patients treated at our clinic from September 2016 to June 2021. Treatment was selected from the topical glaucoma therapy, selective laser trabeculoplasty（SLT）, iStent with phacoemulsification surgery（iStent）, and Ex-PRESS filtration surgery（Ex-PRESS）. We analyzed the change in IOP and CH before and 6 months after treatment in each group. We analyzed IOP（CH）change, IOP（CH）change rate and the correlation between IOP change rate and CH change rate.

Results：We included 152 eyes（PGA, 39 eyes；SLT, 40 eyes；iStent, 31 eyes；Ex-PRESS, 42 eyes）of 152 patients. IOP（CH）change and IOP（CH）change rate were significantly different（p＜0.001）based on treatment. IOP change rate and CH change rate were significantly negative correlated in the Ex-PRESS group and PGA group（p＝0.037, p＝0.002）.

Conclusion：The results of four types of glaucoma treatment in POAG showed that IOP reduction and CH increase varied with the type of treatment, especially Ex-PRESS filtration surgery may increase CH more.