ぶどう膜炎に続発した開放隅角緑内障に対する超音波乳化吸引術と眼内レンズ挿入術

Phacoemulsification and intraocular lens implantation in eyes with well-controlled uveitic glaucoma

　ぶどう膜炎の既往があり，点眼のみで過去3か月間に炎症が沈静化している31眼に超音波乳化吸引術と眼内レンズ挿入術を行った。続発開放隅角緑内障が12眼にあり，19眼には緑内障がなかった。術後に30mmHg以上の眼圧上昇が両群の各2眼で一過性にあったが，有意差はなかった。緑内障群の2眼で術後に眼圧コントロール不良となった。両群の各1眼で術後に炎症が悪化し，硝子体手術が行われた。術後の視力維持ないし改善率は，緑内障群で90％，非緑内障群で72％であった。炎症がコントロールされているぶどう膜炎眼では，続発開放隅角緑内障の既往の有無にかかわらず，白内障に対する超音波乳化吸引術と眼内レンズ挿入術が良好な経過をとることを示す知見である。

We performed phacoemulsification and intraocular lens implantation in 31 uveitic eyes which was well controlled by topical medications for the preceding 3 months at least. Secondary glaucoma was present in 12 eyes and absent in 19 eyes. The intraocular pressure (IOP) was well-controlled at the time of surgery. Postoperatave transient rise of IOP above 30 mmHg occurred in 2 eyes each in both groups. The difference was not significant. The postoperative IOP became poorly controlled in 2 eyes in the glaucoma group. Exacerbation of uveitis developed in one eye each in both groups necessitating vitreous surgery. The visual acuity either improved or remained within one line in 90% of eyes in the glaucoma group and in 72% in the uveitis-only group. The findings illustrate that phacoemulsification with intraocular lens implantation does not adversely affect the course of uveitis or secondary glaucoma which are controlled by topical medications prior to surgery.