網膜静脈分枝閉塞症に対するラニビズマブおよびアフリベルセプト硝子体内投与翌日の成績

Outcome the day after administration of ranibizumab and aflibercept for branch retinal vein occlusion

要約　目的：網膜静脈分枝閉塞症（BRVO）に伴う黄斑浮腫（ME）に対するラニビズマブ硝子体内投与（IVR）およびアフリベルセプト硝子体内投与（IVA）翌日の効果を検討する。

対象と方法：対象は2014年4月〜2023年9月に昭和大学江東豊洲病院眼科にて，未治療のBRVOに伴うMEに対しIVRおよびIVAを施行したIVR群24例25眼（男性11例，女性13例，平均年齢75.8±8.6歳）とIVA群45例46眼（男性18例，女性27例，平均年齢67.8±12.9歳）である。投与前と投与翌日のlogMAR視力ならびに光干渉断層計にて測定した中心網膜厚（CRT）を比較し，投与翌日の効果を後ろ向きに検討した。さらに両群を発症から初回治療までの推定期間3か月未満群と3か月以上群の2群に分類し，計4群で同様の検討を行った。

結果：投与前と投与翌日の平均logMAR視力は，IVR群0.38から0.33，IVA群0.30から0.24となり，IVA群では投与翌日には有意に改善した。平均CRTは，IVR群543.6μmから416.0μmに，IVA群510.6μmから377.7μmに減少し，両群ともに投与翌日には有意に減少した。4群での投与前と投与翌日の平均logMAR視力は，IVR 3か月未満群0.36から0.28，3か月以上群0.41から0.39，IVA 3か月未満群0.29から0.23，3か月以上群0.36から0.28となり，IVR 3か月以上群以外の3群で投与翌日には有意に改善した。平均CRTは，IVR 3か月未満群549.1μmから413.3μm，3か月以上群535.4μmから418.5μm，IVA 3か月未満群517.2μmから390.1μm，3か月以上群483.6μmから326.7μmに減少し，CRTは4群ともに投与翌日には有意に減少した。

結論：投与翌日にはBRVOに伴うMEに対するIVRはCRTをIVAは視力ならびにCRTを改善させた。また，IVR 3か月以上群はCRTをIVR 3か月未満群，IVA 3か月未満群，IVA 3か月以上群は視力ならびにCRTを改善させた。

Abstract　Purpose：We investigated the effect of intravitreal ranibizumab（IVR）and intravitreal aflibercept（IVA）on macular edema（ME）associated with branch retinal vein occlusion （BRVO）.

Subjects and Methods：The subjects included 25 eyes of 24 patients（11 males 13 females, mean age 75.8±8.6 years）in the IVR group and 46 eyes of 45 patients（18 males, 27 females, mean age 67.8±12.9 years）in the IVA group who underwent IVR and IVA for ME associated with untreated BRVO at the Department of Ophthalmology, Showa University Koto Toyosu Hospital, between April 2014 and September 2023. They were devided into the IVR and IVA groups. Both groups were further divided into two groups those with an estimated time from onset to first treatment of＜3 months and those with an estimated time from onset to first treatment of≧3 months. The logMAR visual acuity and central retinal thickness（CRT）measured by optical coherence tomography before and the day after administration were compared and the effect on the day after administration was retrospectively examined.Furthermore, both groups were divided into two groups based on the estimated period from onset to first treatment：one group with＜3 months and one group with≧3 months, and a similar study was conducted on a total of four groups.

Results：The average logMAR visual acuity before and the day after administration was 0.38 to 0.33 in the IVR group and 0.30 to 0.24 in the IVA group, and significantly improved the day after administration in the IVA group. The average CRT decreased from 543.6 μm to 416.0 μm in the IVR group and from 510.6 μm to 377.7 μm in the IVA group, and both groups significantly decreased the day after administration. The average logMAR visual acuity before and the day after administration in the four groups was 0.36 to 0.28 in the IVR group＜3 months, 0.41 to 0.39 in the IVR group≧3 months, 0.29 to 0.23 in the IVA group＜3 months, and 0.36 to 0.28 in the IVA group≧3 months, and significantly improved the day after administration in the three groups other than the IVR group≧3 months. The mean CRT decreased from 549.1 μm to 413.3 μm in the IVR＜3 months group, from 535.4 μm to 418.5 μm in the IVR≧3 months group, from 517.2 μmμm to 390.1 μm in the IVA＜3 months group, and from 483.6 μm to 326.7 μm in the IVA≧3 months group. CRT decreased significantly the day after administration in all four groups.

Conclusion：In ME associated with BRVO, IVR showed improvement in CRT from the day after administration and IVA showed improvement in visual acuity and CRT. In addition the IVR group in which the estimated period from onset to administration was 3 months or more showed improvement in CRT. IVR group in which the estimated period from onset to administration was 3 months or more and two IVA groups showed improvement in visual acuity and CRT.