線維柱帯切除術後早期の眼圧上昇に対する組織プラスミノーゲンアクチベーターの効果

Effect of tissue plasminogen activator on re-elevated intraocular pressure in the early postoperative period after trabecurectomy

　線維柱帯切除術後早期に眼圧上昇をきたした症例に対し，組織プラスミノーゲンアクチベーター（tPA）25μgを前房内に注入し，その効果を検討した。症例は当院にて手術した19例20眼で，注入前後の眼圧，術後tPA注入までの日数，tPA使用眼と非使用眼の経過について検討した。注入前後の平均眼圧は注入前が32.9mmHg，注入翌日が17.4mmHg，翌々日が17.0mmHgであった。注入翌日の眼圧が20mmHg以下を有効とすると，術後10日以内にtPAを注入した症例では有効率が約77％であったのに対し，11日以降では約17％と著しく低下し，10日以内にて十分有効と思われた。また，2週間後，3か月後ともに眼球圧迫などで様子をみた症例より経過は良好で，術後早期の濾過胞閉鎖を回避し得る有効な方法と思われた。

We studied the effect of tissue plasminogen activator (tPA) on re-elevated intra-ocular pressure in the early postoperative period after trabeculectomy. Twenty-five μg of tPA was injected into the anterior chamber of 20 eyes of 19 glaucoma patients, and intra-ocular pressure before and after injection of tPA, the period from operation to tPA injection, and the prognosis compared with eyes in which tPA was not used were estimated. Mean IOP before injection was 32.9 mmHg, and that on the first and second day after injection was 17.4 mmHg and 17.0 mmHg, respectively. The efficacy in achieving an IOP of 20 mmHg or below was 77% in the group injected within 10 days, as compared with 17% in the group injected after 11 days. The prognosis for the cases in which tPA was used was better than in those without it 2 weeks and 3 months after the operation. We think this is a good procedure for avoiding closing of the bleb in the early period after trabeculectomy. The critical period for this procedure seems to be 10 days after trabeculectomy.