緑内障トリプル手術の術式と手術成績の検討

Result of trabeculectomy or trabeculotomy, phacoemulsification and intraocular lens implantation

（C4-1-18）　同一強膜創から緑内障・白内障のトリプル手術を行い，術後6か月以上経過観察できたトラベクレクトミー（レクトミー）併用群12例14眼，トラベクロトミー（ロトミー）併用群23例30眼に対し，両群間の術後成績を比較検討した。最終眼圧はレクトミー群で12.6±2.6mmHg，ロトミー群で13.3±2.6mmHgであった。ロトミー群では術後14日以内の一過性眼圧上昇が有意にみられ，レクトミー群では術後1か月以降に眼圧が上昇する症例があった。両群とも時期は異なるが，眼圧上昇のリスクを認めた。浅前房，脈絡膜剥離などの術後合併症はレクトミー群に多くみられた。ロトミー群は合併症も少なくレクトミー群と比べても最終眼圧に差がないことから，トリプル手術を行う場合は，進行例にもロトミー手術の適応が拡大できる可能性が示唆された。

We reviewed 34 eyes which received simultaneous surgery for glaucoma and cataract. The cases were followed up for 6 months or longer after surgery.All the eyes underwent phacoemulsification and intraocular lens implantation.Trabeculectomy was performed on 14 eyes and trabeculotomy on 30 eyes. The final intraocular pressure (TOP) averaged 12.6 ± 2.6 mmHg in the former group and 13.3 ± 2.6 mmHg in the latter. There was no significant difference between the two groups. Transient rise in TOP within 14 postoperative days was significantly more frequent in eyes treated by trabeculotomy.Eyes treated by trabeculectomy showed, occasionally, rise in TOP one month or later after surgery. Complications including shallow anterior chamber or choroidal detachment was more frequent following trabeculectomy. The findings show the supremacy of trabeculotomy with cataract surgery because of its safety and effectiveness. This procedure may be indicated also for advanced glaucoma.