術中5-フルオロウラシル塗布併用線維柱帯切除術の成績

Outcome of trabeculectomy with intraoperative 5-fluorouracil

　緑内障症例37例43眼に，術中5-フルオロウラシル（5-FU）塗布（50mg／ml,5分間）併用線維柱帯切除術を行い，その成績，併発症についてprospectiveに検討した。ハイリスク群26眼の術前眼圧は27.7±12.6mmHg，終診時眼圧は18.1±7.5mmHgで，ローリスク群17眼の術前眼圧は20.9±5.1mmHg，終診時眼圧は15.9±5.4mmHgであった。生命表法では，術後24か月で無治療で眼圧が20mmHg以下のものはハイリスク群で29.7±9.2％，ローリスク群で52.3±12.3％で，点眼治療を含めて眼圧が20mmHg以下のものはハイリスク群で53.9±9.8％，ローリスク群で63.6±16.6％であった。主な術後併発症は脈絡膜剥離23眼，点状表層角膜症16眼，低眼圧黄斑症7眼，晩期濾過胞漏孔1眼であった。術中5-FU塗布線維柱帯切除術はハイリスク群には不適当であると考えられた。

we prospetively evaluated the effect of trabeculectomy with intraoperative 5-fluorouracil in 43 glaucoma eyes. The series comprised 26 high-risk and 17 low-risk eyes. Following eyes were defined as high-risk ones : past history of glaucoma or cataract surgery, cases under 30 years of age, glaucoma secondary to uveitis and neovascular glaucoma. The intraocular pressure (IOL) in the high-risk group averaged 27.7 ± 12.6 mmHg before surgery and 18.1 ± 7.5 mmHg at the last postoperative visit. The IOP in the low-risk group averaged 20.9 ± 5.1 mmHg before and 15.9 ± 5.4 mmHg after surgery. The success rate, or IOP of 20 mmHg or less without medication at 24 months after surgery, was 29.7 ± 9.2% in the high-risk and 52.3 ± 9.8% in the low-risk group when evaluated by life-table analysis. The success rate with antiglaucoma medications other than oral acetazolamide was 53.9 ± 9.8% in the high-risk and 63.6 ± 16.6% in the low-risk group. Main complica-tions were choroidal detachment 23 eyes, superficial punctate keratitis 16 eyes, hypotonic maculopathy 7 eyes, and late-onset bleb leaks 1 eye. The findings show that trabeculectomy with intraoperative 5-fluorouracil may not induce IOP control in high-risk glaucoma.