視野障害が中心5°以内に及んだ緑内障眼に対する濾過手術の安全性

The risk of trabeculectomy in advanced glaucoma with visual field defect within central five degrees

　原発開放隅角緑内障眼のうち，術前視力が0.1以上で，精密閾値検査の結果Aulhorn-Greve分類V期以上の視野障害を有し，網膜光感度5dB以下の検査点が中心5°以内に存在する末期例39眼を対象として，線維柱帯切除術前後の視力，視野を比較検討した。術後，全例で眼圧が調整され，術直後ならびに経過中中心視野が消失した例はなかった。術前後での視野の変化に影響する術前臨床因子として，重回帰分析の結果，術前mean sensivityにのみ有意な相関がみられ，術前視野障害の高度な例ほど術後感度が上昇する傾向がみられた。末期緑内障眼に対する線維柱帯切除術により術後中心視野が消失する危険は少ないと考えられた。

The risk of sudden visual loss following trabeculectomy in advanced primary open angle glaucoma was evaluated in 39 eyes using Humphrey perimeter program 10-2. All patients had a visual acuity better than 0.1, visual field worse than grade IV of Aulhorn-Greve's classification, and a threshold point equal to or lower than 5 dB within the central 5 degrees of the visual field. After surgery, intraocular pressure was controlled in all eyes without medication. There was no significant change in visual acuity and mean sensitivity (MS) measured by program 10-2, and no case lost the central visual field. Multiple regression analysis showed the correlation between the preoperative MS and the ratio of pre/post MS, showing that postoperative MS increased more in the cases whose preoperative MS was lower. The risk of sudden loss of the central visual field following trabeculectomy seemed to be low even in the advanced stage of glaucoma.