エキシマレーザーの角膜疾患に対する臨床応用

Clinical application of excimer laser to corneal diseases

　波長193nmの弗化アルゴンによるエキシマレーザーで，角膜混濁のある60眼を治療した。翼状片29眼、角膜白斑12眼，帯状角膜変性8眼，顆粒状角膜変性5眼，角膜潰瘍3眼，角膜ヘルペス3眼である。

　全例で角膜混濁を正確な範囲と深さで除去することができた。視力は治療直後から改善した。隣接部角膜に浮腫はなく，治療した角膜面は，平滑で正常な再生上皮で修復された。術後4から12か月の経過観察中，術後屈折の変化による遠視化と切除面の軽度混濁の問題が生じたが，治療後ほぼ3か月で正常化した。エキシマレーザーは，角膜表層の混濁に対して，安全で有効な治療手段であると判断された。

We treated 60 eyes with corneal diseases using a repetitive short-pulsed excimer laser using argon fluoride with the wavelength of 193 nm. The series comprised pterygium 29 eyes, corneal leucoma 12 eyes, band keratopathy 8 cases, granular dystrophy 5 eyes, corneal ulcer 3 eyes and corneal herpes 3 eyes. The treatment was conducted under an oper-ating microscope with the patient in recumbentposition.

The treatment was effective in removing corneal opacity. The treated area was sharply defined in area and depth. Visual acuity improved immediate-ly after treatment. No clinically observable edema developed in the neighboring cornea. Ablated sur-face showed smooth and apparently normal reepi-thelialization.

During the follow up period ranging 4 to 12 months, postoperative hyperoptic shift and slight haze beneath the ablated area appeared to be a problem. These complications were temporary and disappeared 3 months after treatment. The findings suggest that excimer laser can be a safe and effec-tive therapeutic means in superficial corneal dis-eases.