半層角膜弁つき遊離結膜弁移植による損傷した濾過胞の再建術

Repair of leaking blebs using conjunctiva and adjacent half-thickness cornea as free autografts

　損傷した濾過胞を再建するために，半層角膜弁つき遊離結膜弁移植を考案し，2例に実施した。1例は48歳女性で，17歳で両眼に緑内障手術を受け，右眼が失明した。36歳で左眼に再手術を受けた。今回左眼を擦り，濾過胞が損傷した。結膜縫合，有茎結膜被覆は無効であった。濾過胞を切除し，右眼の結膜弁で再建したが，輪部への縫着は困難で，縫合の追加と圧迫眼帯を要した。その2年半後に，打撲により再び濾過胞が損傷した。濾過胞を切除し，輪部に接する角膜を半層切除し，右眼から半層角膜弁つき結膜弁を移植した。縫着は容易で，良好な結果を得た。他の1例は66歳女性で，他医で白内障と緑内障の同時手術を受け，濾過胞が損傷した。結膜縫合と移植は無効であった。当科で本法を実施し，良好な結果を得た。

　We treated 2 eyes to repair leaking blebs by using a piece of conjunctiva and adjacent half-thickness cornea as free autografts. One was a 48-year-old female. She had received glaucoma surgery in both eyes at the age of 17. Her right eye became blind. Another glaucoma surgery was performed on her left eye at the age of 36. She visited us after the filtering bleb in the left eye was damaged by accidental rubbing. After attempts to cover the bleb by conjunctiva proved futile,it could be repaired by excising the bleb and covering the site by a piece of conjunctiva from the contralateral eye. Another 30months later,the bleb was damaged by a blunt trauma. It was cured by applying our procedure described above in the title. The other patient was a 66-year-old female. Simultaneous cataract and glaucoma surgery elsewhere resulted in damaged filtering bleb. Cure was obtained by applying our same procedure.