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要約 目的:滲出性加齢黄斑変性(AMD)に伴う既治療抵抗性の網膜色素上皮剝離(PED)にブロルシズマブ硝子体内注射(IVBr)を行い奏効した6例を報告する。
方法:対象は既存の治療に抵抗性を示したPED症例のうち,2022年6月〜2024年2月に大阪公立大学医学部附属病院眼科でIVBrに切り替え,PEDが改善したAMD 6例6眼(男性3例3眼,女性3例3眼)。典型的AMDが2例,ポリープ状脈絡膜血管症(PCV)が4例,平均年齢75.5歳(66〜83歳)であった。IVBrは全例treat and extend法にて施行し,抗血管内皮増殖因子(抗VEGF)療法からの切り替え例では前治療の投与間隔から開始し,それ以外では5週間間隔で開始した。切り替え前と最終受診時で矯正視力(小数視力をlogMARに換算),中心窩網膜厚(CMT),中心窩脈絡膜厚(CCT)を比較検討した。
結果:IVBr切り替え後の平均観察期間は15.3か月,切り替え前の治療は他の抗VEGF薬,光線力学的療法,選択的色素上皮レーザー治療で,初回治療から切り替えまでの期間は平均97.5か月であった。IVBr切り替え前/最終受診時の平均視力は0.48/0.45,平均CMTは154/112μm,平均CCTは209/165μm,平均PED高は394μおよび検出不能でCMT,CCT,PEDでそれぞれ有意に減少した(p=0.02,0.03,0.01)。PEDが消失するまでの期間は1か月が1眼,3か月が1眼,6か月が1眼,12か月が3眼であった。
結論:治療抵抗性と思われたPEDでも,IVBrで改善が期待できる症例が存在する。
Abstract Purpose:To report six cases of previously refractory retinal pigment epithelial detachment(PED)associated with exudative age-related macular degeneration(AMD)that responded positively to intravitreal brolucizumab injections(IVBr).
Methods:This study included six eyes from six patients(three males and three females)with exudative AMD and refractory PED. These patients were treated with IVBr between June 2022 and February 2024 at the Department of Ophthalmology, Osaka Public University. All patients underwent IVBr using the treat-and-extend(TAE)method, starting at the interval of the previous treatment in patients switching from anti-vascular endothelial growth factor(anti-VEGF)therapy, and at 5-week intervals in all other cases. Corrected visual acuity(converted to logMAR), central macular thickness(CMT), and central choroidal thickness(CCT)were compared before the switch to IVBr and at the final follow-up visit.
Results:The mean observation period following the IVBr initiation was 15.3 months. Prior treatment included other anti-VEGF drugs, photodynamic therapy, and selective pigment epithelial laser therapy, with a mean time from initial treatment to switch of 97.5 months. After switching to IVBr, the mean visual acuity improved from 0.48 to 0.45 at the final follow-up visit, mean CMT from 154 to 112 μm, mean CCT from 209 to 165 μm, and mean PED height from 394 to 0 μm, indicating a significant reduction in CMT, CCT, and PED, respectively(p=0.02, 0.03, and 0.01). PED resolution was achieved within varying timeframes across the six eyes:one eye resolved within one month, another within three months, a third within six months, and the remaining three eyes within twelve months.
Conclusion:IVBr were effective in treating PED associated with exudative AMD in cases previously resistant to existing therapy.

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