慢性閉塞隅角緑内障に対する非穿孔トラベクレクトミーの経験

A case of chronic angle-closure glaucoma treated by nonpenetrating trabeculectomy

　77歳男性が治療に抵抗する両眼の緑内障で紹介された。眼圧は左右とも25mmHgであった。散瞳により眼圧は32mmHgに上昇した。レーザー虹彩切開術とレーザー隅角形成術後の眼圧は左右とも24mmHgとほとんど下降せず，前房深度は右1.9mm，左1.8mmであった。隅角所見などと合わせて，台地状虹彩を伴う慢性閉塞隅角緑内障と診断した。マイトマイシンC併用で非穿孔トラベクレクトミーを両眼に行った。前房深度は術前と同様に維持された。左眼には術直後に濾過胞再建術を，右眼には術後10か月にYAGレーザー隅角穿刺術を追加した。術後1年の眼圧は無治療で右8mmHg，左14mmHgであった。

A 77-year-old male was referred to us for bilateral glaucoma resistant to topical medications. His intraocular pressure (IOP) was 25mmHg in either eye. The IOP rose to 32mmHg in both eyes following mydriasis induced by instillation of 0.5% tropicamide. Following laser iridotomy and laser gonioplasty, the IOP remained at about 24mmHg with topical medication. The depth of the anterior chamber was 1.9mm right and 1.8mm left. Gonioscopy showed plateau iris in both eyes. These findings led to the diagnosis of chronic angle-closure glaucoma.Both eyes then underwent uneventful nonpenetrating trabeculectomy with mitomycin C. The depth of the anterior chamber remained unchanged. The filtering bleb in the left eye had to be modified soon after surgery. Goniopuncture using YAG laser was performed in the right eye 10 months later. One year after the initial surgery, the IOP was 8mmHg right and 14mmHg left without medication.