公衆衛生81巻5号

2017年05月発行

特集 眼の健康とQOL

白内障の現状と対策

著者： 佐々木洋¹

所属機関： ¹金沢医科大学眼科学講座

ページ範囲：P.372 - P.381

白内障の歴史
　ヒンズー医学において，白内障は眼内の液状物質の変性によるものと考えられていた．液状物質はラテン語でsuffusio(血性浸潤)，それがアラブ語で大滝と翻訳され，再度ラテン語に訳されcataractとなったのが語源の由来とされている¹⁾．
　白内障手術は紀元前3000年頃インドでCouching法(白内障墜下法)が行われたという記録がある²⁾³⁾．針で水晶体を硝子体中に落とし，瞳孔領を透明にすることで視力回復を得るという方法である．その後19世紀半ばまで，このCouching法が白内障手術の主な治療法として広く行われていた．日本では室町時代の初期，1350〜1360年頃からCouching法は“針立て”として行われるようになった．Couching法で対応できない症例も多く，水晶体囊を針で切開する切囊術，濁った水晶体を吸引除去する吸引法なども行われた．角膜を切開し，水晶体を眼外に摘出する囊外摘出を1752年に初めて行ったのが，Jacques Davielである．これは画期的な進歩であり，角膜下方を切開し，そこから混濁水晶体を指で圧出して摘出した．しばらくはCouching法も行われていたが，刀や切囊針の改良に伴い，本法が白内障手術の主流となった．1750年代には水晶体を囊ごと全摘出する水晶体囊内摘出術も始まった．摘出の手法により，圧迫法，鑷子法，輪匙法，吸着法，電気凝固法，冷凍凝固法などがある．Joaquín Barraquerによりチン小帯を切断するα-キモトリプシンが導入され，本法は安全に行える手術となった．

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