Trabectomeのlearning curveについての検討

Learning curve of Trabectome for glaucoma

要約　目的：緑内障に対するTrabectome^TMの熟練度の差による結果の報告。対象と方法：緑内障に対してTrabectomeが行われた56例60眼を対象とした。年齢は28～91歳，平均70歳であり，原発開放隅角緑内障34眼，正常眼圧緑内障6眼，落屑緑内障20眼であった。3人の術者が手術を行い，それぞれ最初の10例（計30例）と，これに続く10例（計30例）の結果を評価した。全例で3か月以上の経過を追った。結果：術後の眼圧下降率は，前半30例では16.5±28.0％，後半30例では21.6±20.2％で，両群間に有意差はなかった。Trabectomeの切開範囲，術後の視力低下，術後併発症について，両群間に有意差はなかった。術後の前房出血は，前半群で有意に多かった（p＝0.04）。結論：3人の術者によるTrabectomeで，それぞれ最初の10例とこれに続く10例とで，ほぼ同等な結果が得られた。

Abstract.　Purpose：To report the outcome of Trabectome dependent on the experience by 3 surgeons. Cases and Method：This study was made on 60 eyes of 56 patients who received Trabectome for glaucoma. The age ranged from 28 to 91 years, average 70 years. Primary open-angle glaucoma was present in 34 eyes, normal-tension glaucoma in 6 eyes, and exfoliative glaucoma in 20 eyes. Trabectome was performed by 3 surgeons. The outcome was evaluated for the initial 10 cases each totalling 30 cases and for the next 10 cases each totalling 30 cases. All the cases were followed up for 3 months or longer. Results：Rate of decrease in intraocular pressure averaged 16.5±28.0％ for the initial 30 cases and 21.6±20.2％ for the next 30 cases. The difference was not significant. No significant difference was present regarding the range of Trabectome, visual acuity, or complications after surgery. Postoperative hyphema was more frequent in the initial than next 30 cases（p＝0.04）. Conclusion：Outcome of Trabectome was similar in the initial 30 and next 30 cases when performed by three surgeons.