緑内障のある白内障眼への眼内レンズ挿入術—術後早期の変化

Intraocular lens implantation in glaucomatous eyes.: Early postsurgical results

　緑内障75眼に対する後房眼内レンズ挿入術の術後早期の変化を検討した。眼圧調整に必要な治療は原発閉塞隅角緑内障（PACG）32眼全例と原発開放隅角緑内障（POAG）43眼の大多数例で術前と同じか減少した。POAGでは　30mmHgを越える眼圧上昇が5眼（12％）にあった。術後合併症はPACGで比較的多かった。この結果から以下の手術方針が示唆される。PACG眼では，眼圧調整が薬物療法でできる場合は白内障手術を行う。POAG眼では，内服療法下にある症例では緑内障手術を優先させる。十分な散瞳がえられ，手術操作が比較的容易であるPOAGの症例においては，緑内障手術，白内障摘出，後房眼内レンズ挿入を同時に行うtriple procedureも考慮する。

We implanted posterior chamber lenses in 75 eyes of 58 glaucoma patients. The series comprised 32 eyes with primary angle closure glaucoma (PACG) and 43 with primary open angle glaucoma (POAG). We evaluated the visual functions and the intraocular pressure (IOP) during the initial 3 months after surgery. In all the 32 eyes with PACG, equal or lesser medication was necessary to control the IOP than before surgery. The IOP rose above 30 mmHg in 3 eyes with POAG. Early postoperative complications, including fibrinous reaction and cystoid macular edema, was more frequent in PACG than in POAG eyes. The findings suggest the following therapeutic principles regarding cataract surgery in eyes with glaucoma. Cataract surgery with intraocular lens implantation is indicated in eyes with PACG with well-maintained IOP under medication. In eyes with POAG with controlled IOP under full medication, glaucoma is to be treated either by glaucoma surgery or by triple procedure.