眼科専門病院への緑内障患者の紹介

Referrals to ophthalmologic hospital in patients with glaucoma

要約　目的：井上眼科病院に眼科医療機関から紹介された緑内障患者の特徴の調査。

対象と方法：2019年4〜9月に眼科医療機関より井上眼科病院に初めて紹介された緑内障患者225例225眼を対象とした。性別，年齢，緑内障病型，眼圧，視野障害度，使用中の緑内障薬剤数，紹介形態，紹介目的，診察後の治療方針を診療録から後ろ向きに調査した。

結果：男性99例，女性126例，年齢61.1±15.5歳，18〜88歳であった。正常眼圧緑内障86例，原発開放隅角緑内障77例，続発緑内障34例などであった。眼圧は16.3±7.0mmHg，1〜53mmHgであった。使用薬剤数は2.4±1.7剤，0〜7剤であった。紹介形態は転医191例，セカンドオピニオン34例であった。診察後の治療方針は転医のうち治療方針の是非判断（101例）では方針変更なし68.3％，手術依頼（34例）では手術施行73.5％が多かった。セカンドオピニオンのうち治療方針確認22例では治療方針変更なし86.4％，手術の是非判断8例では手術適応62.5％が最も多かった。

結論：眼科専門病院への緑内障紹介患者は転医症例が85％を占め，目的は治療方針の是非判断，手術依頼の順で，それぞれ治療方針変更なしと手術施行が多かった。

Abstract　Purpose：To investigate the characteristics of patients with glaucoma referred to Inouye Eye Hospital from other ophthalmologic institutions.

Subjects and methods：We enrolled 225 patients（225 eyes）with glaucoma who had been referred to Inouye Eye Hospital from other ophthalmologic institutions for the first time from April to September 2019. The sex, age, type of diagnosis, intraocular pressure（IOP）, degree of visual field defects, number of current medications for glaucoma, purpose of referral, and treatment strategy after the consultation were investigated from medical records.

Results：The subjects were 99 men and 126 women. The mean age was 61.1±15.5 years and the range of age was 18 to 88 years. The types of diagnoses were normal-tension glaucoma in 86 patients, primary open-angle glaucoma in 77 patients, secondary glaucoma in 34 patients, and others. The mean IOP was 16.3±7.0 mmHg（range, 1-53 mmHg）. The number of current medications was 2.4±1.7, and the range was 0 to 7. The purpose of referral was to change doctors in 191 patients and to obtain a second opinion in 34 patients. Of 101 patients referred for changing the doctor, 68.3％ referred for determination of the treatment policy were provided with the same treatment as before. Of 34 patients referred for surgery, 73.5％ underwent the surgery. Of 22 patients referred for a second opinion, 86.4％ referred for determination of the treatment policy were provided with the same treatment. Of 8 patients referred for an opinion regarding the surgery, 62.5％ were still indicative of surgery.

Conclusions：Of all patients with glaucoma referred to the ophthalmic hospital, 85％ were aimed at changing the doctor. The most common purpose of referral was determination of the treatment strategy, followed by surgery. The most common outcome in these purpose groups was the determination of the same treatment strategy and the indication of strategy, respectively.