アクリルソフト眼内レンズを用いた白内障・緑内障同時手術の術後早期成績

Early postoperative results after combined trabeculectomy, and cataract surgery using acrylic soft intraocular lens

　アクリルソフト眼内レンズを用い，白内障と線維柱帯切除術との同時手術を施行し術後3か月以上経過観察できた58例70眼の術後早期成績について検討した。手術は結膜弁，強膜弁作成，マイトマイシンC塗布洗浄，前嚢切開，強膜弁下よりPEA,IOL挿入，trabeculectomy，強膜弁，結膜弁縫合という手順で行った。術後3か月の視力は58％で0.5以上を得た。術後3か月および6か月時の15mmHg以下の無投薬眼圧コントロール率は98％および90％であった。術後フィブリン析出が21％，浅前房が20％，脈絡膜剥離が26％，一過性眼圧上昇が10％，低眼圧黄斑症が4.3％にみられた。本術式は緑内障手術以外の創口をほとんど必要とせず，IOLに起因する合併症や重篤な合併症がないことより有用と考えられた。

We performed combined trabeculectomy and cataract surgery using acrylic soft intraocular lens in 70 eyes. The surgical procedure included: creation of conjunctival and scleral flaps, application and irrigation of mitomycin C, anterior capsulorhexis, phacoemulsification, intraocular lens implantation beneath the scleral flap, trabeculectomy and suture of scleral and conjunctival flaps in the listed order. At 3 months after surgery, visual acuity of 0.5 or better was achieved in 58% of the eyes. Control of intraocular pressure below 15mmHg without medication was achieved in 98% at 3 months and in 90% at 6 months after surgery. Postoperative complications included: fibrinous exudation 21%, shallow anterior chamber 20%, choroidal detachment 26%, transient spike of intraocular pressure to 31mmHg or over 10%, and hypotonic maculopathy 4.3%. This technique appeared to be safe and effective by requiring almost no wounds except those of glaucoma surgery and by the absence of serious complications related to intraocular lens implanta-tion.