血管新生緑内障に対する4直筋切腱・再縫合術の検討

Tenotomy of four rectus muscles for neovascular glaucoma

　眼圧上昇が著しく，眼球摘出を考慮せざるを得ない眼圧コントロール不良で視機能の悪い（手動弁〜0）血管新生緑内障12例12眼に対して，4直筋切腱と付着部の毛様体冷凍凝固時に7本の前毛様動脈の遮断と再疎通の防止が期待できる4直筋切腱・再縫合術を試み，その効果を3〜32か月（平均10.9か月）にわたり検討した。71〜30mmHg［平均47.4±10.7 mmHg （S．D．）］の術前眼圧は，44〜0mmHg （平均9.3±12.7 mmHg）と術後有意の低下を示した（P＜0.001）。虹彩ルベオーシスは，術後は12眼中11眼の91.7％になんらかの消退をみた。眼痛，頭痛などの自覚症状の改善は，全例に認められた。

　これにより本法は，視機能の改善の余地のある血管新生緑内障に対する治療としては今後慎重に選択されるべきものと思惟されるが，この種の難治性のものに対しては，所期の目的が達せられ，有効な手術方法と判定された。

We performed full-width tenotomy to all the four rectus muscles in 12 eyes with uncontrollable neovascular glaucoma. The visual acuity ranged from no light perception to hand motion. As the surgery was intended to disrupt all the anterior ciliary vessels on the rectus muscles, we added cryoapplication to the site of insertion beforeresuturing of the severed muscles. The cases were followed up for 3 to 32 months, average 11 months.

At the end of follow-up, the visual acuity deter-iorated in 6 eyes and remained stationary in the other 6. The intraocular pressure level decreased from the preoperative level of 47.4±10.7 mmHg to 9.3±,12.7 mmHg without additional medical ther-apy. The decrease was significant (p＜0.001). The intraocular pressure remained below 10 mmHg in 8 eyes, 4 of which became phthisic. Rubeosis iridis became inconspicuous in 11 eyes. There was no complaint of ocular pain or headache after surgery.

The findings suggest that the current surgical procedure is beneficial in the management of un-controllable neovascular glaucoma with extremely poor vision.