急性閉塞隅角緑内障に対する硝子体手術を併用した超音波白内障手術成績

Outcome of cataract surgery with core vitrectomy for acute angle-closure glaucoma

要約　目的：急性閉塞隅角緑内障に対し，初回治療として硝子体手術を併用した白内障手術の成績の報告。対象と方法：過去20か月間に手術を行った14例16眼を対象とした。男性4眼，女性12眼であり，年齢は57～86歳（平均74歳）であった。術前眼圧は平均56.3mmHgであった。全例に水晶体乳化吸引術と眼内レンズ挿入術を行い，硝子体手術（core vitrectomy）を6眼に，隅角癒着解離術を1眼に行った。10眼は水晶体乳化吸引術の経験が3年未満の術者が施行した。結果：全例で眼内レンズを囊内に固定できた。隅角癒着解離術とレーザー虹彩切開術を各1例に行った以外は，術後に問題はなかった。最終眼圧は全例が22mmHg以下で，平均11.8mmHgであり，16眼中12眼が無投薬であった。結論：急性閉塞隅角緑内障に対し，硝子体切除を併用した水晶体乳化吸引術と眼内レンズ挿入術は眼圧を低下させ，術中または術後の合併症が少なく，手術経験年数が短い術者でも可能である。

Abstract.　Purpose：To report the results of cataract surgery with vitrectomy for acute angle-closure glaucoma. Cases and Method：This retrospective study was made on 16 eyes of 14 patients who received surgery during the past 20 months. The series comprised 4 male and 12 female eyes. The age ranged from 57 to 86 years, average 74 years. Intraocular pressure（IOP）averaged 56.3mmHg before surgery. All the eyes received phacoemulsification-aspiration followed by implantation of intraocular lens（IOL）. Additional core vitrectomy was performed on 6 eyes. Goniosynechialysis was performed on one eye. Cataract surgery was performed in 10 eyes by surgeons with less than 3 years of training. Results：Intraocular lens could be fixated in the bag in all the eyes. There was no postoperative complications except one eye each that needed laser iridotomy or goniosynechialysis. Final IOP was below 22mmHg in all the eyes and averaged 11.8mmHg. Medication could be discontinued in 12 out of 16 eyes after surgery. Conclusion：Cataract surgery and IOL implantation with or without core vitrectomy is effective for acute angle-closure glaucoma, induces IOP control, and has minor intra-or postoperative complications. This surgical modality can be performed by surgeons with less than 3 years of experience.