CW Nd：YAGレーザー経強膜毛様体光凝固の安全性と有効性の検討

Safety and effectiveness of contact transscleral cyclophotocoagulation with continuous-wave Nd: YAG laser

　接触型CW Nd：YAG laser経強膜毛様体光凝固を眼圧コントロール不良な難治性緑内障27症例30眼に施行した。接触凝固用プローブの前端を角膜輪部より後方1.0mmの位置に置き，照射エネルギー1.8〜9.2J，照射後6〜36で毛様体ひだ部を光凝固した。術前眼圧の平均は39.2±3.2mmHg，最終眼圧の平均は22.0±1.6mmHgで，最終的に全例で眼圧下降が得られた。術前眼圧が30mmHg以下の症例では4J,10発前後の照射で長時間眼圧コントロールが期待できるが，術前眼圧が50mmHg以上の症例では6J,20発前後の照射を施行し，必要に応じて追加凝固を検討するほうが安全と考えられた。

We treated 30 eyes with uncontrolled intraocularpressure (IOP) by applying transscleral cyclo-photocoagulation with continuous-wave Nd:YAGlaser. Photocoagulation was placed 1 mm posteriorto the limbus. We used power output from 1.8 to9.2J totalling 6 to 36 applications along the circum-ference. The IOP level decreased from the pretreat-ment average of 39.2±3.2 mmHg to 22.0±1.6mmHg after a mean of 7.6 months after treatment.Additional treatment was required in 12 eyes forsuccessful control of IOP. Typically,10 applica-tions of laser at 4J sufficed to normalize thepretreatment IOP level of 30 mmHg. For eyes withIOP values of 50 mmHg or higher, 20 applicationsat 6 J were necessary to decrease the IOP, withadditional laser applications one month later when-ever necessary. Complications were minimal. Theabove early results suggest the usefulness of thismethod in the treatment of absolute glaucoma andintractable glaucoma with still useful vision.