白内障と緑内障同時手術の長期予後—トラベクレクトミーとトラベクロトミーの比較

Longterm results of simultaneous surgery for cataract and glaucoma. Comparison between trabeculectomy and trabeculotomy

　白内障を合併した緑内障症例53例66眼に対し，白内障と緑内障同時手術および白内障単独手術を施行し術後長期経過をKaplan-Meier生命表分析により検討した。線維柱帯切開術併用群（13眼）における眼圧コントロールの生存率は0.55±0.16（4年），線維柱帯切除術併用群（19眼）では0.73±0.10（4年）となり両群間に有意差を認めなかった。白内障単独手術群（34眼）の生存率は，開放隅角群（17眼）で0.58±0.16（2年），閉塞隅角群（17眼）で0.94±0.06（2年）と閉塞隅角群に有意に良好であった（P＜0.05）。線維柱帯切除術併用群における濾過胞の生存率は，0.31±0.12（2年）であり濾過胞が消失しても眼圧コントロールが良好な症例を認めた。

We reviewed the longterm course of intraocular pressure (IOP) in 66 eyes of 53 glaucoma patients that underwent surgery for cataract and/or glaucoma. The series included primary open angle glaucoma 25 eyes, primary closed angle glaucoma 23, capsular glaucoma 7, traumatic glaucoma 4 and glaucoma secondary to iritis 7. In 34 eyes, extracapsular cataract extraction with intraocular lens implanta-tion (ECCE+IOL) was performed alone (group 1). Simultaneous surgery with (ECCE+IOL) and trabeculotomy was performed in 13 eyes (group 2). Simultaneous surgery with (ECCE+IOL) and trabeculectomy was performed in 19 eyes (group 3). When the postoperative course was evaluated by Kaplan-Meier life table analysis, the survival probabilities of IOP at 4 years were 0.55±0.16 for group 2 and 0.73±0.10 for group 3. There was no significant difference between the two groups. In group 1, the survival probability at 2 years was 0.94±0.06 for 17 eyes with closed angle glaucoma and 0.58±0.16 for 17 eyes with open angle glaucoma. The difference was significant (p＜0.05). In group 3, the survival probability of filtering bleb was 0.31±0.12 at 2 years. The intraocular pressure was well-controlled even after disappear-ance of filtering bleb in several eyes.