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2 眼 内 レ ン ズ 挿 入 術 後Cystoid 1 Patient Characteristics 2 Patient Characteristics Macular 1 Edemaの 発 生率 3 Fluorescein by blivake's angiographv classification 2 Mean }SD Specula:角 膜 内 皮 細 胞Axial Glasses て.表2に 2.方 1)術 Correction:眼 Length:眼 軸 長 垂 竟矯 正 示 す. 法 式 お よ び.一 連 の 臨 床 検 査 手 術 は い ず れ も20年 Fig. 以 上 自 内 障 手 術 を 行 っ た2名 熟 練 者 で 行 な わ れ た.通 1 Angiographic study) の い た15-17).両 レ ン ズ と も ル ー プ 角10度 FAに の 光 学 系6mm の シ ン グ ル ピ ー ス 後 房 眼 内 レ ン ズ が 用 い ら れ た.手 よ る 評 価 は 三 宅 分 類6に な い 症 例 を グ レ ー ド0,傍 術用 る も の を グ レ ー ド1,中 顕 微 鏡 に よ る光 障害 を 予 防す る た め顕 微 鏡 に有 害 光 吸 収 グ レ ー ド2,そ フ ィ ル タ ー を 装 着 し て 手 術 が 行 わ れ た.手 3と 評 価 を 行 っ た. Betamethasone18)の 及 びDiclofenac の 後3週 た.退 眼 を1日4回 行 い,そ 計50眼 目,12週 目 に 行 っ た.12週 に 青 色 光 眼 内 レ ン ズ が,26眼 予 定 さ れ た.術 術4 6週 月eで あ っ た,24眼 に無 着色 の紫 外線吸 収眼 内 レ ン ズ が 挿 入 さ れ た. 50眼 連 説)は 施 行 し 作為 に行 っ たグ 上 で あ っ た 手術 か ら 評 価 実 施 日 ま で の 平 均 間 隔 は3.1ケ 目 価 方法 に で き る 隈 り 全 例FA6,19)が 例 がFAを 全 て が 評 価 の 対 象 と な っ た.無 ル ー プ 問 の 視 力 結 果 は 全 例0.8以 正 視 力 検 査 な どの 術 後 一 般 の 目,4週 果 後 嚢 破 嚢 等 の 術 合 併 症 は な く,全 眼 及 びDiclofenac ず つ 行 わ れ術 後 治 療 は 中 止 され 後 炎 症 に よ る 障 害(PGs関 cein漏 目 に ピー の 患 者 のFA結 果 を 表3に CMEの そ の う ち グ レ ー ド1症 を 評 価 の 時 期 と し た. 例 で,グ 161 示 す,図1にFluores- 出 を み た一 症 例 を 示 す.本 上のAngiographic クを持 つ こ とよ りその 影響 の少 ない 最 も早 期 で あ る術 後 12週 して 重 度 の 漏 出 を認 め る もの を グ レ ー ド 結 に 行 っ た 視 力 検 査 が 本 試 験 で 用 い ら れ た. 術 後12週 出 を全 く認め 心 窩 全 周 に漏 出 を認 め る も の を 眼 を1日6回 眼8.9)を1日4回 院 後 の 屈 折 検 査,矯 2)評 沿 い,漏 中 心 窩 にわ ず か に 漏 出 を認 め 結 膜 下 注 射 を 受 け た.術 sodium点 諸 検 査 は 術 後1週 術 後 に患 者 は 間 はBetamethasone点 間 はFluorometholone点 sodium点 in this 内 レン ズ は 青 色 光 吸 収 眼 内 レ ン ズ と紫 外 線 吸 収 眼 内 レ ン ズ を 用 後 翌 日 か ら1週 1-case 常 の 手術 と同様 に水 晶 体 超 音 波 乳 化 吸 引 術 後 に 眼 内 レ ン ズ 挿 入 術 を 行 な っ た.眼 0.8mg CMIE (Grade レ ー ド3症 例 は6例 試 験 の グ レ ー ド1以 発 生 率 は22%で で.グ 例 は な か っ た.各 あ っ た. レ ー ド2症 例 は5 眼 内 レ ンズ の 有意
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4 1) Hitchings RA, Chisholm IH and Bird AC: Aphakic macular edema: incidence and pathogenesis. Invest Ophthalmol 14:68-72, ) Hitchings RA: Aphakic macular edema : a two-year follow-up study. Br J Ophthalmol 61: , ) Miyake K, Sakamura S and Miura H : Long-term follow-up study on prevention of aphakic cystoid macular edema by topical indomethacin. Br J Ophthalmol 64 : , ) Miyake K, Shirasawa E and Hikita M : Hypotheses on the role of prostaglandins in the pathogenesis of epinephrine maculopathy and aphakic cystoid macular edema. Prog Clin Biol Res 312 : , ) Solomon LD : Efficacy of topical f lurbiprof en and indomethacin in preventing pseudophakic cystoid macular edema. Flurbiprofen-CME Study Group I. J Cataract Refract Surg 21: 73-81, ) Miyake K : Prevention of cystoid macular edema after lens extraction by topical indomethacin (I). A preliminary report. Albrecht Von Graefes Arch Klin Exp Ophthalmol 203: 81-88, ) Kraff MC, Sanders DR, Jampol LM, et al: Effect of an ultraviolet-filtering intraocular lens on cystoid macular edema. Ophthalmology 92 : , ) Eichenbaum DM, Jaffe NS, Clayman HM, et al: Pars plana vitrectomy for complications of intraocular lens implantation. Ophthalmic Surg 8: , ) Sander B, Larsen M and Engler C : Diabetic macular oedema : a comparison of vitreous fluorometry, angiography and retinopathy. Br J Ophthalmol 86 : , ) West SK, Rosenthal FS, Bressler NM, et al: Exposure to sunlight and other risk factors for age-related macular degeneration. Arch Ophthalmol 107: , ) Padilla S, Real RP and Vallet-Regi M: In vitro release of gentamicin from OHAp/ PEMA/ PMMA samples. J Control Release 83: , ) Nilsson SE : Are there advantages in implanting a yellow IOL to reduce the risk of AMD? Acta Ophthalmol Scand 82: , ) Sparrow JR, Miller AS and Zhou J: Blue light-absorbing intraocular lens and retinal pigment epithelium protection in vitro. J Cataract Refract Surg 30: , ) Karacorlu M, Ozdemir H and Karacorlu S: Intravitreal triamcinolone acetonide for the treatment of chronic pseudophakic cystoid macular oedema. Acta Ophthalmol Scand 81: , ) Wright PL, Wilkinson CP, Balyeat HD, et al: Angiographic cystoid macular edema after posterior chamber lens implantation. Arch Ophthalmol 106 : , ) Mentes J, Erakgun T, Afrashi F, et al : Incidence of cystoid macular edema after uncomplicated phacoemulsification. Ophthalmologica 217 : , ) Taylor DM, Sachs SW and Stern AL: Aphakic cystoid macular edema. Longterm clinical observations. Surv Ophthalmol 28 (Suppl) : , ) Miyake K, Ichihashi S and Shibuya Y : Blood-retinal barrier and autof luorescence of the posterior polar retina in long-standing pseudophakia. J Cataract Refract Surg 25: , ) Okuno T and Saito H : Evaluation of bluelight hazards from various light sources. Dev Ophthalmol 35: , ) Norren D and Schellekens P : Blue light hazard in rat. Vision Res 30: , 163
5 ) Kraff MC, Lieberman HL, Jampol LM, et al: Effect of a pupillary light occluder on cystoid macular edema. J Cataract Refract Surg 15 : , ) Lin Z, Li S, Liu Y, et al: The comparative analysis of the complications of extracapsular cataract extraction with and without posterior chamber intraocular lens implantation. Yan Ke Xue Bao 9:90-92, (in Chinese) 27) Goodman DF, Stark WJ and Gottsch JD: Complications of cataract extraction with intraocular lens implantation. Ophthalmic Surg 20: , ) Pollack A, Marcovitch A, Bukelman A, et al: Development of exudative age-related macular degeneration after cataract surgery. Eye 11: , ) Falsini B. Piccardi M, Iarossi G, et al : Influence of short-term antioxidant supplementation on macular function in age-related maculopathy : a pilot study including electro- physiologic assessment. Ophthalmology 110: 51-60, OCCURRENCE OF CYSTOID MACULAR EDEMA AFTER CATARACT SURGERY Masahiko TSUKAHARA, Yoko TAGUCHI, Yukiko YAMAMOTO, Toshihiko VEDA and Ryohei KOIDE Department of Ophthalmology, Showa University School of Medicine Abstract \The purpose of the study was to investigate prospectively the incidence of cystoid macular edema (following CME) after cataract surgery including intraocular lens implants. The 35 subjects (50 eyes) were from 40 to 80 years of age. Patients with systemic disease such as diabetes mellitus and ocular disease were excluded. In addition, axial length and operation time were unified to reduce influence to CME as much as possible. Fluorescein leakage from the macular was evaluated according to Miyake's classification using fluorescein angiography (following FA) three months after cataract surgery. There were no postoperative complications ; a total of 50 eyes were subjects of evaluation. The incidence of angiographic CME was 22% in this study. It was higher than clinical CME. It is more precise and important to invest prospectively controlled cases. Key words : cystoid macular edema, intraocular lens, fluorescein angiography, cataract surgery
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