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<title>前視野緑内障に向き合う（電子版のみ） | 株式会社文光堂</title>


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<meta name="description" content="緑内障は従来視野異常で発見され治療に回されていたが，OCTの発達・普及により視野異常の出現前に発見される緑内障が増えてきている．前視野緑内障PPGと呼ばれる疾患を発見した時，そもそも治療すべきか，どのように管理して行くべきかについては，専門家の中でも意見の分かれる所であり，臨床眼科医の中でも戸惑いが多い．今回，緑内障の専門家が集まり，現時点でのPPGの定義・診断・治療を詳らかにした．それによって，">

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		<h1 class="catchCopy">偶然にPPGを見つけてしまった時，慌てないための，診断・治療指針！</h1>
		

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					編集：中澤　徹（東北大学教授）
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				<ul class="property"><li class="disc">B5判・248頁・4色刷</li><li class="disc">ISBN&nbsp;978-4-8306-5548-7</li><li class="disc">2016年10月15日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">緑内障は従来視野異常で発見され治療に回されていたが，OCTの発達・普及により視野異常の出現前に発見される緑内障が増えてきている．前視野緑内障PPGと呼ばれる疾患を発見した時，そもそも治療すべきか，どのように管理して行くべきかについては，専門家の中でも意見の分かれる所であり，臨床眼科医の中でも戸惑いが多い．今回，緑内障の専門家が集まり，現時点でのPPGの定義・診断・治療を詳らかにした．それによって，第一線の眼科医が日常診療ですぐに応用できるスタンダードを示した．</section><section class="preface">序　文<br><br>　緑内障は網膜神経節細胞の不可逆性な慢性変性疾患であり，加齢でも網膜神経節細胞の減少や機能低下が起こります．緑内障から生涯にわたる良好なQuality of Vision（QOV）を守るために，また失明予防の観点からも，早期発見・早期治療が重要です．視神経乳頭陥凹拡大やリムの菲薄化，網膜神経線維層欠損など緑内障を示唆する構造変化が認められるものの，通常の自動静的視野検査では異常を認めない状態は前視野緑内障（preperimetric glaucoma，PPG）と称されます．前視野緑内障の概念は一般眼科医にはまだ十分に浸透しておりませんが，昨今のOCT普及により，臨床現場で前視野緑内障に該当する症例に遭遇する機会が急増しています．前視野緑内障とどう向き合うかは，緑内障において大切な早期発見・早期治療において避けることのできない課題であり，今だからこそ議論すべき重要なテーマです．<br>　前視野緑内障のエビデンス構築を目指した取り組みが始まりつつありますが，現段階では，前視野緑内障の明確な治療方針は示されておらず，多くの眼科医がいかに治療していくべきか頭を悩ませているのが現状です．本書は，前視野緑内障の病期に焦点を絞り，概念，診断，治療，管理に関する最新情報を整理し，前視野緑内障に関する理解を深め，診療の在り方を提案したいと思います．本書の執筆者はいずれも第一線で診療に当たっておられる緑内障を専門とされる先生方で，前視野緑内障との向き合い方について，私見も含めより実践的な内容で，余すところなく記載していただきました．読者が自らのレベルと興味に応じて，わかりやすく適切な情報を得られるように，「解説」，「ワンポイントアドバイス」，「トピックス」の3つのカテゴリーに分類し構成しております．<br>　前視野緑内障をテーマに，最も病状を反映しうる検査項目や，適切な治療開始時期，治療の評価方法についてなど，本書の活用により緑内障診療レベルの向上および診療の標準化の一助になることを願っております．緑内障では失った視機能を回復することは現状では叶いません．早期発見と適切な管理により，失明ゼロを目指し，その実現につなげることができれば幸いです．<br><br>2016年10月<br>中澤　徹</section><section class="indexes">はじめに<br>　今，前視野緑内障にどう向き合うのか<br>I 緑内障の生涯治療における前視野緑内障管理の位置づけ<br>II　前視野緑内障の歴史的背景<br>　1．前視野緑内障の用語の歴史<br>III　前視野緑内障の診断方法<br>　1．前視野緑内障の診断の流れ（総論）<br>　2．前視野緑内障診断における各眼科検査の有用性と注意点<br>　　1）眼底検査<br>　　2）視野検査<br>　　3）特殊視野検査<br>　　4）OCT乳頭周囲<br>　　5）OCT黄斑<br>　　6）OCT乳頭，篩状板<br>　　7）血流検査<br>One Point Advice<br>　視神経乳頭の解剖<br>　陳旧性血管閉塞・脳疾患と前視野緑内障との鑑別<br>　OCT検査の注意点<br>Topics<br>　電気生理学的検査でどこまで緑内障を評価できるか？<br>　中枢視路MRI検査で緑内障が見つかるのか？<br>　緑内障遺伝子解析の最前線<br>　樹状突起は，前視野緑内障発症解明の手がかりとなるか？<br>IV　前視野緑内障の治療<br>　1．前視野緑内障の治療の流れ（総論）<br>　2．治療開始のタイミング<br>　3．前視野緑内障の薬物治療<br>One Point Advice<br>　点眼薬の全身副作用<br>　点眼薬の局所副作用<br>　白内障手術と眼圧下降<br>Topics<br>　アドヒアランスを向上するために<br>　新しい緑内障手術<br>V　前視野緑内障の管理<br>　1．前視野緑内障の進行判定の全体像<br>　2．前視野緑内障進行判定における各眼科検査の有用性と注意点<br>　　1）眼底検査<br>　　2）視野検査<br>　　3）OCT<br>One Point Advice<br>　乳頭形状と臨床的表現型<br>　視野検査の再現性<br>　視野検査進行判定に役立つソフトウエア<br>　OCT検査時の注意点<br>3．前視野緑内障進行における危険因子の活かし方<br>　1）眼圧<br>　2）近視<br>　3）血流<br>　4）全身疾患・酸化ストレス<br>One Point Advice<br>　高眼圧症のエビデンス<br>　眼圧日内変動<br>　角膜ヒステレシス<br>Topics<br>　24時間眼圧測定器の現状<br>　強度近視と緑内障OCT検査<br>索　引</section></article>
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