原発開放隅角緑内障症例への選択的レーザー線維柱帯形成術の追加治療成績

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  • ゲンパツ カイホウ グウカク リョクナイショウ ショウレイ エノ センタクテキ レーザー センイ チュウタイ ケイセイジュツ ノ ツイカ チリョウ セイセキ
  • Clinical Results of Selective Laser Trabeculoplasty as Adjunctive Treatment for Primary Open-angle Glaucoma Patients

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Abstract

目的:最大耐用薬剤使用中の原発開放隅角緑内障症例へ追加治療として施行した選択的レーザー線維柱帯形成術(SLT)の効果をレトロスペクティブに検討すること. 対象と方法:対象は, 手術既往のない原発開放隅角緑内障症例のうち, 初めてSLTを施行された34例34眼である. 年齢61.1±13.0(平均値±標準偏差, 以下同様)歳, 観察期間7.1±4.8か月, 術前投薬数3.5±0.7剤であった. 0.5～1.4mJで57.0±11.5発, 隅角半周に照射した. 結果:術前眼圧20.9±3.4mmHgが, 術1か月後18.7±4.6mmHgに有意に下降した(p<0.01). Kaplan-Meier法による6か月後および12か月後の生存率は, それぞれ48.6%, 23.2%であった. 結論:SLTが有効であったのは6か月後で約半数にとどまり, 日本人における最大耐用薬物療法下での追加治療としてのSLTには限界があることが示唆された. Purpose:We retrospectively investigated the intraocular pressure(IOP) lowering effects of selective laser trabeculoplasty(SLT) as adjunctive treatment for glaucoma patients receiving maximal medical therapy. Methods:Thirty-four eyes of 34 patients with primary open-angle glaucoma who had no prior surgical therapy and has received SLT for the first time were included in this study. The results of their laser treatment were analyzed retrospectively. The age of patients was 61.1±13.0(mean±standard deviation) years, the follow-up period was 7.1±4.8 months, and the number of medications before SLT was 3.5±0.7. A total of 57.0±11.5 spots were placed over 180° of the trabecular meshwork at energy levels ranging from 0.5 to 1.4 mJ per pulse. Results:The IOP significantly decreased from 20.9±3.4 mmHg at baseline to 18.7±4.6 mmHg at 1 month after SLT(p<0.01). Kaplan-Meier survival analysis showed that success rates at 6 and 12 months after SLT were 48.6% and 23.2%, respectively. Conclusions:Although SLT significantly decreas ed the IOPs in Japanese patients with primary open-angle glaucoma receiving maximal medical therapy, the effects may be for a limited time only, as adjunctive treatment. Nippon Ganka Gakkai Zasshi(J Jpn Ophthalmol Soc 111:953-958, 2007)

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