角膜切開超音波白内障手術の論点—術後眼内炎，術中合併症について

Problem of phacoemulsification-aspiration cataract surgery by corneal incision regarding postoperative endophthalmitis and intraoperative complications

（18-G409-12）　角膜切開超音波白内障手術で問題とされている術後眼内炎の発生頻度と，術中合併症の対処法および予後について検討した。術後眼内炎は1991年から1996年の9,050　眼中9眼で発生し，頻度は0.1％で，強角膜切開によるものと同等だった。9眼中4眼で腸球菌が検出されたため，1996年より術中の眼内灌流液にイミペネム／シラスタチンの添加を始めた。以後，4,841眼で眼内炎の発生はない。後嚢破損は1996年の2,710眼中97眼（3.6％）で生じたが，IOL挿入中断や瞳孔偏位はなかった。角膜切開は前部硝子体切除が容易で後嚢破損時には有利であると思われた。創口の熱損傷は16眼（0.6％）で生じたが，創の閉鎖不全はなかった。

We reviewed a series of 9,050 eyes which underwent cataract surgery by phacoemulsification-aspiration by corneal incision during the 6 years through 1996. Endophthalmitis developed in 9 eyes (0.1%) . The incidence was the same in another series treated by sclerocorneal incision. Enterococcus faecalis was isolated in 4 of the 9 eyes. This finding induced us to add imipenem and cilastatin sodium to the irrigating solution. No endophthalmitis developed in 4,814 eyes thereafter. Rupture of posterior capsule occurred in 97 of 2,710 eyes (3.6%) operated during 1996. This accident was not an obstacle in consequent insertion of intraocular lens nor induced dislocation of the pupil. Burn happened in 16 eyes (0.6%) but did not interfere with sealing of the wound. The findings show the advantage of cataract surgery by corneal incision, as anterior vitrectomy can be performed following accidental rupture of posterior capsule.