開放隅角緑内障に対するNd：YAGレーザー隅角線維柱帯照射

Efficacy and safety of Nd : YAG laser trabeculotomy in open angle glaucoma

　開放隅角緑内障21例27眼に対してYAGレーザー隅角線維柱帯照射を行い平均約26週間の経過を観察した．27眼中26眼で眼圧は治療後に低下し，さらに27眼中16眼（59.3％）では臨床的に有用と考えられる眼圧下降効果を得た．このうち，9眼では照射後に眼圧下降薬剤を中止ないし減量し得，また40歳以下の若年者でも眼圧の有意な低下例を認めた．合併症として照射時の疼痛を6例に，照射後の軽度の虹彩炎は全例に，一過性の眼圧上昇を3眼に認めたが，いずれも軽度に留まつた．

　以上より，今後効果持続期間，照射方法など検討する点はあるものの，YAG隅角照射治療は開放隅角緑内障眼に対する治療として有望であると考えられた．

We treated a series of 27 eyes, 21 patients, with various types of open-angle glaucoma by directingQ-switched pulsed Nd : YAG laser beam at the trabecular meshwork. Cases were followed up for 8 to 36 weeks, average 26 weeks.

The intraocular pressure (IOP) decreased below the pretreatment level in 26 eyes. A clinical mean-ingful effect, as defined by us, was obtained in 16 eyes (60%) after treatment.

When the laser beam was applied to the me-shwork, blood reflux was seen in 7 eyes (26%). Vaporization at the immediate laser site was seen in all the eyes. This finding seemed to suggest that the application of YAG laser beam created an opening in the meshwork which would lead to an improvement in the facility of outflow and to IOP decrease.

The YAG laser therapy allowed a tapering off or a complete cessation of medical treatment in 9 out of clinically meaningful 16 eyes. In terms of posttreatment decrease of IOP, 4 out of 7 eyes under 40 years of age showed a significant effect.

Serious complications were consistently absent. Minor eye pain was complained of by 6 patients during treatment. All the eyes manifested flare and cells in the anterior chamber, which subsided in a couple of days. A temporary rise in IOP occurred following treatment in 3 eyes.

Our findings indicate the usefulness of Nd : YAG treatment at the trabecular meshwork for various types of open-angle glaucoma, particularly those under maximally tolerated medical therapy and for juvenile patients.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(7) : 998-1002, 1988