緑内障の検眼鏡的眼底所見と視野の関連性

Funduscopic findings as related to visual field in glaucoma

　緑内障の疑いがある252人，421眼を検索した。眼底検査には細隙灯顕微鏡にコンタクトレンズを併用した。症例の内訳は，正常眼圧緑内障192眼，嚢性緑内障と開放隅角緑内障88眼，急性隅角閉塞緑内障25眼，高眼圧症25眼などであった。ハンフリー視野計のglaucoma hemifield testが正常範囲にある12眼のすべてに神経線維層欠損（nerve fiver layer defect：NFLD）があった。乳頭陥凹が偏位している例では，ハンフリー30-2静的視野検査でのmean deviationが有意に低下またはcor—rected pattern standard deviationが上昇していた。Zoneβと豹紋状眼底の症例では，その程度に応じて視野感度が低下していた。閉塞隅角緑内障では乳頭陥凹が小さく，神経線維層欠損の頻度が小さかった。初期緑内障の診断と重症度の判定では，神経線維層欠損と乳頭陥凹の程度が特に重要であった。閉塞隅角緑内障，zoneβと豹紋状眼底が目立つ例では，眼底所見による緑内障の程度判定は困難であった。

A total of 421 eyes in 252 patients were examined regarding early glaucomatous changes. The series in-cluded normal-tension glaucoma 192 eyes, capsular or primary open-angle glaucoma 88, closed-angle glaucoma 25, ocular hypertension 25 and others. Fundus findings were evaluated using slit-lamp microscope with fundus contact lens. There were 12 eyes that showed normal findings by glaucoma hemifield test by Humphrey perimetry. All these eyes had nerve fiber layer defect. Eyes with notching of disc cupping showed significantly lower mean deviation and higher corrected pattern standard deviation by static perimetry by Humphrey 30-2 program. Eyes with zone β or tes-selated fundus showed decreased sensitivity related to their severity. Eyes with closed-angle glaucoma showed signifi-cantly smaller disc cupping and less frequent nerve fiber layer defect. As an overall finding, disc cupping and nerve fi-ber layer defect were important changes in early glaucoma. Fundus findings were of lesser importance in grading the severity of glaucoma in eyes of closed-angle glaucoma, zone ,3 or tesselated fundus.