隅角癒着解離術が奏効した続発性閉塞隅角緑内障の1例

Goniosynechialysis worked in a case with aphakic angle-closure glaucoma

　70歳男性．術前狭隅角であったが，手術経過良好であった白内障嚢内摘出術後7日目に起こった浅前房から，癒着性閉塞隅角緑内障にいたる経過について述べ，隅角癒着解離術が奏効をみたことについて報告した．すなわち，術前の眼圧50mmHg／Appが，術直後より全く薬物投与なしに恒常的に15mmHg／APP前後となり，視力は術後矯正0.9となった．手術手技は，1984年永田ら^1）によって報告された方法に基づき，少量の硝子体を切除吸引し，Thorpeのgonioprismで，隅角を直視しつつ，前房を灌流しながら癒着剥離を行った．癒着はきわめて容易に剥離され，術中すでに，手術部の隅角の構造がほぼ明瞭に観察され，現在に至る1年間，そのまま開放状態を保ち，再発をみていない．

A 70-year-old male developed temporary flat ante-rior chamber and peripheral anterior synechia, or goniosynechia, 7 days after uneventful intracapsular cataract extraction in his left eye. Apparently due to goniosynechia, the intraocular pressure (IOP) started to rise 2 months later. As the IOP was persistently ele-vated in spite of maximum medication and additional iridectomy, we performed goniosynechialysis as des-cribed below over the inferior temporal quadrant.Thereafter, the IOP, corrected visual acuity and the objective findings were in satisfactory states. In performing goniosynechialysis, we basically fol-lowed the description by Nagata et al in 1984. After removing a small amount of the vitreous, the peripheral anterior synechia in the inferior temporal quadrant was released under direct observation through Thorpe's goniolens. The thus dissected portion of the chamber angle remained open throughout the observation period of 12 months.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(1) : 38-40, 1987