緑内障眼における1％ドルゾラミド点眼の視神経乳頭血流に及ぼす影響

Blood flow in the optic nerve head following instillation of 1％ dorzolamide in eyes with glaucoma

要約　目的：ドルゾラミド点眼が緑内障眼の視神経乳頭の血流に及ぼす影響の報告。対象と方法：緑内障患者11例11眼を対象とした。男性5例，女性6例で，年齢は54～78歳（平均68歳）である。6例が正常眼圧緑内障，4例が原発開放隅角緑内障，1例が慢性閉塞隅角緑内障であった。乳頭と視野所見とから，緑内障は初期～中期であった。それまでの治療に加え，1％ドルゾラミド点眼を追加し，2か月後の乳頭血流をレーザースペックル法で測定した。結果：眼圧は有意に低下し，血圧と眼灌流圧に変化はなかった。乳頭血流を示す指標は，乳頭陥凹部と下耳側リムで有意に増加した（p＜0.05）。結論：緑内障眼への1％ドルゾラミド点眼により，眼圧が下降し，視神経乳頭の血流が増加した。以上からドルゾラミド点眼は緑内障眼での視神経を保護する可能性がある。

Abstract.　Purpose：To report changes in blood flow in the optic nerve head after topical 1％ dorzolamide in glaucomatous eyes. Cases and Method：This prospective study was made on 11 eyes of 11 patients with glaucoma. The series comprised 5 males and 6 females. The age ranged from 54 to 78 years,average 68 years. Normal-tension glaucoma was present in 6 cases,primary open-angle glaucoma in 4,and chronic closed-angle glaucoma in one. Funduscopic and perimetric findings showed the glaucoma to be in initial to middle stage in the majority of cases. Patients started additional instillation of 1％ dorzolamide. Circulation in the optic nerve head was measured before and 2 months after instillation of dorzolamide using a laser-speckle flowgraphy. Results：Intraocular pressure decreased significantly after 2 months of instillation. There was no change in blood pressure or ocular perfusion pressure. Laser-speckle flowgraphy showed significant increases in blood flow in the cupping and inferior-temporal segment of rim area（p＜0.05）. Conclusion：Instillation of 1％ dorzolamide resulted in decrease of intraocular pressure and increase in circulation in the optic nerve head. Instillation of dorzolamide may have a neuroprotective effect in glaucomatous eyes.