線維柱帯切除と後房レンズ挿入の同時手術—術後早期の経過

Early clinical course after trabeculectomy and simultaneous posterior chamber intraocular lens implantation

　線維柱帯切除と後房レンズ挿入同時手術（trabeculectomy＋PC-IOL挿入）を行った59例69眼の術後早期の経過について強角膜，結膜切開法別に，また緑内障病型別にretrospectiveに検討した。術後早期の眼圧は，切開法別では結膜輪部切開と強膜輪部切開の組み合わせ群が，結膜円蓋部切開と強膜輪部切開の組み合わせ群および角膜切開群に比し有意に高く，緑内障病型別では術後1日目に続発緑内障群が他群に比し高眼圧を呈した。全対象69眼の合併症出現頻度は，フィブリン反応38（55.1％），一過性眼圧上昇16（23.2％），脈絡膜剥離4（5.8％），浅前房5（7.2％），前房出血11（15.9％）で，この合併症は虹彩処置の有無および5—Fluorouracil術後投与と関連がなかった。同時手術では以上を考慮し症例，術式の選択，術後管理を行うべきと考えられた。

We reviewed the early course after combined surgery with trabeculectomy and posterior cham-ber intraocular lens implantation in 69 eyes of 59 patients. The intraocular pressure (I0P) at first postoperative week was significantly higher in eyes operated with fornix-based conjunctival flap and sclerocorneal incision than those with limbus-basedconjunctival flap and sclerocorneal incision or limbus-based conjunctival flap and corneal incision. IOP on the first postoperative day was significantly higher in eyes with secondary glaucoma than those with primary open-angle or angle-closure glaucomas. Postsurgical complications included fibrinous exudation 55%, transient IOP spike 20%, choroidal detachment 6%, shallow anterior cham-ber 7% and hyphema 15%. These postoperative complications and the IOP on the first postoper-ative day were independent of surgical manipula-tion of the iris or postoperative injections of 5- fluorouracil.