非穿孔性線維柱帯切除術の線維柱帯切開術併用効果

Effect of modified nonpenetrating trabeculectomy with or without trabeculotomy

　非穿孔性線維柱帯切除術（NPT）の線維柱帯切開術（TLO）併用効果を64眼について検討した。内訳は，原発開放隅角緑内障39眼，嚢性緑内障9眼，正常眼圧緑内障8眼，原発閉塞隅角緑内障4眼，ステロイド緑内障4眼である。31眼にはNPTのみを行い，33眼にはこれとTLOを併用した。術中マイトマイシンCは36眼に行った。白内障同時手術を38眼に行った。平均17か月の観察期間後の眼圧平均値はNPT単独群15.8mmHg，併用群12.2mmHgであり，薬物スコアはNPT群1.6点，併用群0.9点で，いずれも併用群がNPT単独群より有意に低かった。Kaplan-Meier法を用いた生存率曲線の検討では，術後眼圧16mmHg以下と14mmHg以下へのコントロールは，併用群が有意に良好であった。全症例を通じて，浅前房，低眼圧黄斑症などの重篤な合併症はなかった。NPTにTLOを併用することで，進行した緑内障に対しても良好な眼圧コントロールが可能であると考えられた。

We reviewed 64 eyes which received nonpenetrating trabeculectomy (NPT) with or without trabeculotomy (TLO). The series comprised primary open-angle glaucoma 39 eyes, capsular glaucoma 9 eyes, normal-tension glaucoma 8 eyes, primary closed-angle glaucoma 4 eyes, and corticosteroid glaucoma 4 eyes. Out of 64 eyes, 31 received NPT only and 33 received combined surgery with NPT and TLO. Mitomycin C was used intraoperatively on 36 eyes. Simultaneous cataract surgery was performed on 38 eyes. After follow-up averaging 17 months, the intraocular pressure (IOP) averaged 15.8mmHg in NPT group and 12.2mmHg in the combined group. The drug score averaged 1.6 in the former group and 0.9 in the latter. The difference in IOP decrease and drug score was significant (p=0.003 and p=0.01 respectively). The survival rate regarding IOP below 16mmHg and 14mmHg was significantly better in the combined group than in NPT group. There was no severe postoperative complication throughout. The findings show that a better IOP control may be achieved by the combined surgery even in advanced glaucoma.