視野指標からみた緑内障の進行要因

Visual field indices as parameters for progression of glaucoma

　緑内障35名54眼につき，視野を含む諸所見の変化を平均5.3年間追跡した。嚢性緑内障を含む原発開放隅角緑内障23眼，慢性閉塞隅角緑内障8眼，正常眼圧緑内障23眼である。視野検査にはハンフリー静的視野30-2プログラムを用い，mean deviation （MD）とcorrected pattern standard　deviation （CPSD）を検索した。正常眼圧緑内障ではMDが有意に低く（p＜0.01），CPSDが有意に高かった（p＜0.001）。原発開放隅角緑内障と慢性閉塞隅角緑内障では，MDとCPSDは眼圧と視神経乳頭陥凹の進行に相関しなかった。正常眼圧緑内障では，3眼を除き，眼圧が13mmHg以上の例に視野が進行する傾向があり，MDの低下とCPSD上昇とに相関した（p＜0.05,p＜0.01）。MD値が—5dB以下，またはCPSDが6dB以上の正常眼圧緑内障では，眼圧を13mmHg以下に維持すべきであると結論される。

We followed up 54 eyes of 35 eyes of glaucoma for an average of 5.3 years. The series comprised primary open-angle glaucoma including capsular glaucoma 23 eyes, chronic closed-angle glaucoma 8 eyes and normal-tension glaucoma 23 eyes. We used a Humphrey Visual Field Analyzer with 30-2 program. Eyes with normal-tension glaucoma showed signifiantly lower values of mean deviation (MD) (p＜0.01) and significantly higher values of corrected pattern standard deviation (CPSD) (p＜0.001). Neither MD nor CPSD was correlated with the progression of optic disc cupping in primary open-angle or closed-angle glaucoma. There was a tendency for visual field progression in normal-tension glaucoma except in 3 eyes when the intraocular pressure (IOP) was over 13mmHg. Visual field progression was also significantly correlated with lower MD (p＜0.05) and higher CPSD (p＜0.01). The findings show that the intraocular pressure in normal-tension glaucoma ought to be kept below 13mmHg particularly when the MD is less than -5dB or CPSD is over 6dB.