正常眼圧緑内障における視野障害進行例に対する線維柱帯切除術の効果

Effects of trabeculectomy on eyes with normal-tension glaucoma with progressive visual field damage

　経時的に，中心30度内視野障害程度の指標であるmean deviation （Humphrey30-2 statpac，以下MD）が有意に低下した正常眼圧緑内障（NTG）21例21眼（術前眼圧16.0±2.1mmHg，術直前MD—11.8±8.7dB）に対して線維芽細胞増殖阻害剤を併用した線維柱帯切除術を行い，術後視野障害進行をprospectiveに検討した。術後平均24か月（最低12か月）の経過観察において，最近3回の平均眼圧は9.2±3.2mmHgであった（p＜0.01）。また，術前におけるMDの経時的変化が−1.48±1.0dB／yearに対して術後＋0.13±1.27dB／yearと上昇し（p＜0.01），この結果，MDが経時的に有意に低下するNTGにおいて，線維柱帯切除術は，MD悪化防止に有用であることが示唆された。

We reviewed the effects of trabeculectomy on 21 eyes with normal tension glaucoma withprogressive visual field damage. Solution of antiproliferative agent, 5-fluorouracil in 13 eyes and mitomycinC in 8 eyes, was topically applied to the surgical wound. The patients were followed up for 12 months or moreafter surgery, average 24 months. The intraocular pressure (IOP) before surgery averaged 16.0±2.1mmHgwith mean deviation of-11.8±8.7dB. The eyes showed a significantly mean deviation slope by theHumphrey STATPAC program (p＜0.05). The IOP decreased significantly to 9.2±3.2mmHg after surgery(p＜0.01). The mean deviation slope after surgery averaged-1.48±1.0dB per year. It was significantlygreater than the preoperative value of +0.13±1.27dB per year (paired t-test, p＜0.01). The results showthat trabeculectomy with antiproliferative agent is effective in reducing the IOP and delaying furtherdeterioration of visual field in eyes with normal tension glaucoma.