2年以上経過観察した緑内障患者の治療成績―手術治療群と薬物治療群の比較

Clinical course of glaucoma over two years: Comparison of medically and surgically treated eyes

　可能な限り目標眼圧に近づけるように治療した緑内障160例270眼の経過を追跡した。平均観察期間は58.6±27.6か月であった。134眼は薬物のみで治療し，136眼には手術を行った。薬物群の眼圧は15mmHg前後で推移したが，使用薬剤数を数量化した薬剤スコアは42か月の時点で6.3点であり，治療開始時の約3倍であった。手術群の術後眼圧は14mmHgで推移したが，薬剤スコアは術後12か月の時点で4.6点であった。視野障害の進行は，両群とも，治療前の湖崎分類がⅡaまでの初期症例に多かった。薬物群では薬物治療の長期化が視野障害の進行に影響した可能性があり，手術群では手術の時期と術式を再検討する必要があると思われた。

　We reviewed the clinical course of 270 eyes of 160glaucoma patients. Utmost efforts were made to achieve the optimum intraocular pressure（IOP）. The patients were followed up for an average of 58.6±27.6months. A group of 134 eyes were treated by medication only. The other group of 136 eyes received surgery. In medically treated eyes,the IOP remained at or around 15mmHg. The drug score averaged 6.3 points,or three times the value at the start. In surgically treated eyes,the IOP remained at or around 14mmHg. The drug score averaged 4.6 points 12months after surgery. In both groups,the visual field defect showed a tendency to progress in early to moderately affected eyes. Prolonged use of medication appeared to be a contributory factor for the observed progression of field defect. In surgically treated eyes,choice of time and surgical modality appeared to need reappraisal.