原因疾患と角膜移植術後眼圧上昇の相関

Relationship between ocular hypertension after penetrating keratoplasty and causative diseases

　過去5年7か月間に行った全層角膜移植術の症例で，1か月以上経過が観察できた183眼につき，術後の眼圧上昇に関係する因子を検討した。角膜移植術を必要とした原因疾患は，炎症性134眼と非炎症性49眼であった。炎症性の内訳は，水疱性角膜症51眼，角膜白斑49眼，角膜穿孔14眼などであり，非炎症性のそれは，円錐角膜40眼と角膜ジストロフィ9眼であった。22mmHgを超える術後の眼圧上昇の頻度は，炎症群で39％，非炎症群で41％であり，有意差はなかった。炎症群での眼圧上昇は，原因疾患により隅角に器質的または機能的な問題があったためと推定した。副腎皮質ステロイド薬による眼圧上昇の頻度は，炎症群で15％，非炎症群で65％であり，後者で有意に高率であった（p＜0.0001）。角膜移植術後の眼圧上昇が，原因疾患で機序が異なることを示す所見である。

We reviewed 183 eyes that received penetrating keratoplasty during the past 67 months. They were followed up for one month or longer after surgery. We tried to identify factors involvled in postoperative ocular hypertension. Keratoplasty was performed for inflammatory and non-inflammatory eye diseases. The former comprised 134 eyes and included bullous keratopaty 51 eyes, corneal leucoma 49 eyes, corneal perfo-ration 14 eyes and others. The latter comprised 49 eyes and included keratoconus 40 eyes and corneal dystro-phy 9 eyes. Postoperatively, ocular hypertension to more than 22mmHg occurred in 39% of eyes with inflam-matory diseases and in 41% of eyes with non-inflammatory ones. There was no statistical significance be-tween the two groups. It appeared that ocular hypertension in the inflammatory group was due to anatomical or functional problems in the chamber angle. The incidence of steroid-induced ocular hypertension was 15% in inflammatory group and 65% in non-inflammatory group. The difference was significant (p＜0.0001). The findings show that ocular hypertension after penetrating keratoplasty may differ depending on causative dis-eases.