和歌山県立医科大学附属病院での線維柱帯切除術の術後早期成績―円蓋部基底結膜切開と輪部基底結膜切開の比較

Comparison of short-term outcome of fornix- and limbal-based trabeculectomy for glaucoma in our institution

要約　目的：緑内障に対する円蓋部または輪部基底結膜切開による線維柱帯切除術の短期成績の比較。対象と方法：2012年までの4年間に線維柱帯切除術を行った48例62眼を対象とした。男性28例，女性22例で，原発開放隅角緑内障34眼，原発閉塞隅角緑内障11眼，落屑緑内障13眼，続発緑内障4眼であった。円蓋部基底切開を27眼，結膜切開を35眼に行った。手術の3か月後にその成績を評価した。結果：手術の3か月後の眼圧は，円蓋部基底切開群で有意に低かった（p＝0.0058）。視力，薬剤の投薬スコア，周術期の合併症，追加処置については，両群間に差がなかった。強膜フラップのレーザー切糸は，円蓋部基底切開群で有意に多かった（p＝0.03463）。結論：円蓋部基底切開群では，周術期に追加処置を要した症例が少なく，良好な眼圧が得られ，強膜フラップのレーザー切糸の症例が有意に多かった。

Abstract.　Purpose：To compare the short-term outcome of trabeculectomy for glaucoma by fornix- and limbal based incision. Cases and Method：This retrospective study was made on 62 eyes of 48 cases that received trabeculectomy during 4 years through 2012. The series comprised 28 males and 22 females. There were primary open-angle glaucoma 34 eyes, primary closed-angle glaucoma 11 eyes, capsular glaucoma 13 eyes, and secondary glaucoma 4 eyes. Trabeculectomy was performed by fornix-based incision in 27 eyes and limbal-based incision in 35 eyes. The outcome was evaluated 3 months after surgery. Results：Intraocular pressure after surgery was significantly lower in eyes receiving fornix-based incision（p＝0.0058）. There was no difference between the two groups regarding visual acuity, medication score, complications during or after surgery, or additional treatment. Laser suture lysis of scleral wound was performed more frequently in eyes receiving fornix-based incision（p＝0.03463）. Conclusion：Eyes treated by fornix-based incision resulted in less frequent treatment during or after surgery, better intraocular pressure control, and higher incidence of laser suture lysis.