西葛西・井上眼科病院における白内障手術併用iStent inject® Wの短期成績

Short-term outcomes of cataract surgery with iStent inject® W

要約　目的：白内障手術併用眼内ドレーン挿入術（iStent inject^® W）の術後成績について検討する。

対象と方法：2021年4月〜2023年5月に西葛西・井上眼科病院で白内障手術併用iStent inject^® W挿入術を施行され，3か月以上経過観察できた連続症例（iStent群）16例24眼（71.9±4.2歳）と，白内障単独手術を施行された緑内障眼（単独群）15例26眼（71.8±5.6歳）を対象とし，視力（logMAR），眼圧，薬剤スコア，合併症について後ろ向きに検討した。

結果：術翌日の視力はiStent群，単独群で両群間に差はみられず，術後2週間までに観察期間中における最大視力に達した割合もiStent群88％（21眼），単独群85％（22眼）と有意差はなかった。術前，術後1，3か月の平均眼圧と（下降率）はiStent群で18.3±3.2mmHg，16.9±2.7mmHg，15.6±2.4mmHg（14.7％）（p＝0.0002），単独群で13.5±2.3mmHg，13.4±2.9mmHg，12.5±1.7mmHg（7.4％）（p＝0.0035）であり，両群とも術前と比べて術後3か月で有意に下降し，さらにiStent群は単独群と比べても有意な眼圧下降を認めた（p＝0.036）。薬剤スコアはiStent群で2.0±1.8，0.42±0.98，0.58±1.0，単独群で1.3±1.2，1.4±1.0，1.3±1.0で，iStent群において，すべての時期で有意に減少した。術後の一過性眼圧上昇（≧30mmHg）をiStent群に4眼，単独群に1眼認め，両群間に有意差はなかった。ニボーを形成するような前房出血を生じた例はなかった。

結論：白内障手術併用iStent inject^® W挿入術は，白内障手術単独に比べて有意な眼圧下降と同等の早期視力改善を得られる安全で有用な手術である。

Abstract　Purpose：To evaluate the postoperative outcome of cataract surgery with intraocular drain insertion（iStent inject^® W）.

Patients and Methods：This retrospective study included 24 eyes of 16 patients（71.9±4.2 years old）undergoing cataract surgery combined with iStent inject^® W insertion（iStent group）, and 26 eyes of 16 patients（71.8±5.6 years old）undergoing cataract surgery alone（Alone group）between April 2021 and May 2023 at Nishi-kasai Inouye Eye Hospital. All patients had cataracts and glaucoma and could be followed up for at least 3 months. Visual acuity（logMAR）, intraocular pressure（IOP）, glaucoma medication score, and complications were recorded.

Results：There was no significant difference in visual acuity one day post surgery between the iStent and Alone groups, and there was no significant difference in the number of eyes achieving maximum visual acuity by two weeks post surgery, 88％（21 eyes）in the iStent group and 85％（22 eyes）in the Alone group. The mean IOP（reduction rate）before surgery and at 1 and 3 months after surgery was 18.3±3.2 mmHg, 16.9±2.7 mmHg, and 15.6±2.4 mmHg（14.7％）（p＝0.0002）, respectively, in the iStent group respectively, and 13.5±2.3 mmHg, 13.4±2.9 mmHg, and 12.5±1.7 mmHg（7.4％）（p＝0.0035）, respectively, in the Alone group. A significant decrease was observed in both groups at 3 months after surgery, and a larger IOP reduction was seen in the iStent group compared to the Alone group（p＝0.036）. The glaucoma medication scores before surgery and at 1 and 3 months after surgery were 2.0±1.8, 0.42±0.98, 0.58±1.0 in the iStent group respectively, and 1.3±1.2, 1.4±1.0, 1.3±1.0 in the Alone group, indicating a significant reduction in the iStent group at all timepoints. Postoperative IOP spike（≥30 mmHg）was observed in four eyes in the iStent group and one eye in the Alone group, with no significant differences. No eyes had hyphema with forming niveau.

Conclusion：Cataract surgery with iStent inject^® W insertion is a safe and useful procedure that provides not only a significant reduction in both IOP and glaucoma medication scores but also an early visual acuity improvement comparable to cataract surgery alone.