嚢性緑内障に対する改良非穿孔性線維柱帯切除術

Outcome of modified nonpenetrating trabeculectomy for capsular glaucoma

　嚢性緑内障（CG）11例12眼に対して改良非穿孔性線維柱帯切除術を行い，原発開放隅角緑内障（POAG）18例25眼の結果と比較した。術後成績は，CG群で21.8±8.7か月後，POAG群で平均21.5±6.9か月後に評価した。薬剤使用中の術前眼圧は，CG群で23.4±5.4mmHg,POAG群で22.4±3.3mmHgであり，術後眼圧は，それぞれ17.0±5.0mmHg,13.4±3.7mmHgで，前者が有意に高かった（p＝0.018）。降圧薬を使用しない最終眼圧が14mmHg以下である頻度は，CG群83％，POAG群52.0％で，前者が有意に低かった（p＝0.011）。濾過胞形成は，CG群50％，POAG群88％であり，前者が有意に低かった（p＝0.019）。本術式は，POAGには有効であるが，CGでの眼圧下降は不十分であった。嚢性緑内障では，偽落屑物質が沈着する残存線維柱帯での房水流出抵抗が大きいことが推定される。

We performed modified nonpenetrating trabeculectomy on 12 eyes of 11 cases of capsular glau-coma and 25 eyes of 18 cases of primary open angle glaucoma (POAG). The final outcome was evaluated after 21.8±8.7 months in capsular glaucoma and after 21.5±6.9 months in POAG. The presurgical intraocular pressure (IOP) averaged 23.4±5.4mmHg in capsular glaucoma and 22.4±3.3mmHg in POAG under medi-cation. The final IOP averaged 17.0±5.0mmHg and 13.4±3.7mmHg respectively. The difference was signifi-cant (p=0.018). The incidence of IOP less than 14mmHg without medication was 8.3% in capsular glaucoma and 52.0% in POAG. The difference was significant (p=0.011). Filtering bleb was formed in 50% of capsular glaucoma and in 88% of POAG. The difference was significant (p=0.019). The present surgical method was thus effective for POAG and less effective for capsular glaucoma. There is a possibility that a high resistance to aqueous outflow may persist in capsular glaucoma due to residual pseudoexfoliative material in the trabecu-lar meshwork.