Nd-YAG laser経強膜毛様体光凝固術の眼圧下降効果

Transscleral Nd-YAG laser cyclophotocoagulation for uncontrolled glaucoma and its pressure lowering effect

　Nd-YAG laser経強膜毛様体光凝固術を施行した難治性緑内障のうち，6か月以上経過観察し得た24例26眼における眼圧下降効果を統計学的に検討した。照射条件はfree running　mode，照射数8から35スポット，照射エネルギー3.9から5.7J，照射総エネルギー35.6から164.9J，照射部位は角膜輪部より2から2.5mmとした。施行6か月後の眼圧下降率と，施行前眼圧，照射数，総エネルギーとの間に，有意の正の相関があった（0.001＜P＜0.01）。

　合併症としての低眼圧と眼球癆を避けるために，初回施行時は半周照射にとどめ，効果不十分で複数回施行する場合，前回照射時より1週後に半周照射をくり返すのが，安全な施行法であると思われた。

To investigate the pressure lowering effect of the procedure statistically, 26 eyes of 24 patients suffer-ing from a variety of uncontrolled glaucoma were treated with noncontact transscleral Nd-YAG laser cyclophotocoagulation and followed prospectively for a minimum of 6 months. A Lasag Microruptor II was used in the free running mode. Eight to 35 pulses, mean 19 pulses, were given 2mm to 2.5mm from the limbus with an energy per pulse of 3.9J to 5.7J, mean 4.7J, and total laser energy deliveredper treatment was 35.6J to 164.9J, mean 91.1J. Linear regression analysis was performed using proportional pressure reduction 6 months after procedure as a function of the pretreatment intraocular pressure, the number of pulses and the total energy per treatment. There was strong posi-tive correlation (0.001＜p＜0.01). To avoid hypotony and phthisis bulbi, no more than 180" should be treated at first session. If sufficient pres-sure reduction is not obtained, 180° should be treat-ed repeatedly 1 week after the previous session.