超音波水晶体乳化吸引術と計画的水晶体嚢外摘出術での術後炎症の差

Postsurgical inflammation following cataract surgery. Comparison between phacoemulsification and planned extracapsular extraction

　後房眼内レンズを挿入したケルマン超音波水晶体乳化吸引術（KPE）55眼と計画的水晶体嚢外摘出術（PECCE）33眼の術後炎症の差を検討した。両群で水晶体核の硬さや年齢などの背景因子は同一とした。術後1週間まで測定を行ったフレアー強度，細胞数は共にKPEにおいて低く，フレアー強度は術後1,2日目で（p＜0.01），細胞数は1,2,3日目で（p＜0.01），両術式間に有意の差を認めた。この原因は，両術式の眼侵襲の差を反映したものと思われ，closed eye surgeryとしてKPEの有用性を示すと考えられた。術中灌流液量およびKPEにおける超音波発振時間と術後炎症の程度についても検討を行った。灌流液量が100ml以下の群でその差は有意ではなかった。超音波時間が60秒をこえるものでは強い術後炎症が観察され，超音波時間60秒以下の群との間に，術後1,2,3日目（p＜0.01）で有意差を認めた。

We compared the postsurgical inflammation after posterior chamber lens implantation follow-ing Kelman phacoemulsification (KPE) in 55 eyes and planned extracapsular extraction (PECCE) in 33 eyes. Intensity of aqueous flare and cell count served as parameters for the inflammatory state. Assignment of 88 eyes either to KPE or PECCE procedure was made on randomized basis. Both groups matched as to age and hardness of the lens nucleus.

Postsurgical flare intensity and cell count were lower in KPE than in the PECCE group. The differ-ences were significant for flare on day 1 and 2 postsurgically (p＜0.01) and for cell count on day 1, 2 and 3 (p＜0.01).

The findings appeared to be attributable to the lesser surgical invasion with KPE than with PECCE procedure. Cases treated with more than 100 ml of irrigating solution tended to show a higher but nonsignificant postsurgical inflammation. When ultrasound was applied for 60 seconds or more, both postsurgical flare and cells became markedly more intense than with shorter application on day 1, 2 and 3 after surgery.