緑内障失明予防における介入効果のレトロスペクティブ分析：三次医療提供体制における検討

The global prevalence rate of glaucoma blindness is extremely high and is a leading cause of irreversible blindness. Despite many advancements in treatment, evaluating glaucoma blindness remains challenging due to the long time required for its development and the combined use of treatment modalities.

To evaluate the effectiveness of various treatment modalities in preventing glaucoma-related blindness using a 5-year retrospective study from a tertiary care hospital in Thailand.

A retrospective, cross-sectional study was conducted on 1031 glaucoma patients diagnosed between October 2017 and September 2022. Patients with advanced pterygium, corneal opacity, or macular degeneration were excluded. Data on demographics, clinical characteristics, and treatment modalities (medications, phacoemulsification with intraocular lens implantation [PE with IOL], laser iridotomy [LI], and trabeculectomy) were analyzed. Blindness was defined according to WHO criteria. Multivariate logistic regression assessed associations between blindness and risk factors.

Of the 1031 patients, 21.0% experienced blindness. Secondary glaucoma (SG) had the highest blindness rate (33.5%) compared to primary open-angle glaucoma (POAG, 19.0%) and primary angle-closure glaucoma (PACG, 19.9%). Multimodal interventions significantly reduced blindness in POAG (adjusted OR: 0.57; 95% CI: 0.38-0.87; p = 0.027), but no significant benefit was observed in PACG or SG. PE with IOL showed the lowest blindness rate (14.9%), while trabeculectomy had the highest (47.2%). Treatment initiation within 5 years of diagnosis did not significantly affect blindness rates.

Multimodal interventions effectively reduce blindness in POAG but not in PACG or SG. Future studies should explore the impact of adherence, IOP fluctuation, and secondary glaucoma etiology on outcomes to optimize treatment strategies.