過去3年間の緑内障手術時期と術式

A three-year review on the timing and procedure of glaucoma surgery

　1993年1月〜1995年4月に長崎大学附属病院で行った緑内障手術151眼について術式と術前後の眼圧，視野について検討した。術前視野は全症例の68％，30歳以下では80％が湖崎分類Ⅲ期以降の進行例であった。術後眼圧で14mmHg以下となった症例は線維柱帯切開術30％，線維柱帯切除術50％であり，進行例に対し線維柱帯切開術の降圧作用は不十分と考えられた。線維柱帯切開術は原発開放隅角緑内障より水晶体嚢性緑内障で有意に術後眼圧が低かったが，線維柱帯切除術には各病型間に差はなかった。白内障との同時手術と単独手術には術後眼圧に有意差はなかった。術後視野が進行した8眼中7眼は進行例であり，早期治療の重要性を示唆していた。

We reviewed 151 eyes operated for glaucoma during the foregoing 28 months. Advanced visual field defect was already present in 68% of the eyes and in 80% of patients under 30 years of age. The surgical procedures included trabeculotomy, trabeculectomy, goniosynechiolysis and cyclocryocoagulation. Reduc-tion of intraocular pressure to 14 mmHg or less was obtained in 30% after trabeculotomy and in 50% after trabeculectomy. Trabeculotomy was siginificantly more effective for capsular glaucoma than primary open angle glaucoma. There was no difference in the effect of trabeculectomy among different types of glaucoma. There was no difference in the hypotensive effect whether glaucoma surgery was performed alone or combined with cataract surgery. Postoperative deterioration in visual field developed in 8 eyes, 7 of which advanced visual field defect was already present at the time of surgery. These findings show the importance of early treatment for glaucoma.