網膜静脈分枝閉塞症に伴う黄斑浮腫に対するラニビズマブとアフリベルセプトの実臨床における治療効果

Real-world clinical outcomes of ranibizumab and aflibercept in the treatment of macular edema secondary to branch retinal vein occlusion

要約　目的：網膜静脈分枝閉塞症の黄斑浮腫に対するラニビズマブ（Ra）とアフリベルセプト（Af）による必要時治療の効果を検討した。

対象：初回治療93例93眼（Ra群22眼，Af群66眼，スイッチ5眼）を後ろ向きに検討した。

結果：治療前視力（logMAR値）は両群で差はなく，3か月後はAf群が良好（Ra群0.31±0.26，Af群0.21±0.28，p＝0.03）で，その後差はなくなった。治療前中心網膜厚はAf群が高値（Ra群430±97μm，Af群541±155μm，p＝0.002），3か月後はAf群が低値（Ra群413±128μm，Af群341±124μm，p＝0.01）で，その後差はなくなった。12か月間の治療回数はAf群が少なかった（Ra群4.1±1.1回，Af群3.2±1.0回，p＜0.001）。

結論：実臨床上では，AfはRaより浮腫軽減効果と持続期間が長いが，再治療を適切に行えば12か月後の視力と解剖学的予後に差はない可能性がある。

Abstract　Purpose：To compare the real-world clinical outcomes of a pro-re-nata regime of ranibizumab（Ra）and aflibercept（Af）treatment for macular edema secondary to branch retinal vein occlusion.

Participants and Methods：Treatment naïve 93 eyes of 93 patients（group Ra, 22 eyes；group Af, 66 eyes；switched, 5 eyes）were investigated retrospectively.

Results：There was no significant difference in baseline best-corrected visual acuity（BCVA）in the two groups. However, the BCVA of group Af was significantly better in month 3（group Ra, 0.31±0.26；group Af, 0.21±0.28, p＝0.03）, with no significant difference thereafter. Although baseline central retinal thickness（CRT）was higher in group Af（group Ra, 430±97 μm；group Af, 541±155 μm, p＝0.002）, CRT was significantly smaller in group Af at month 3（group Ra, 413±128 μm；group Af, 341±124 μm, p＝0.01）, and no significant difference was observed thereafter. Group Af had fewer treatments（group Ra, 4.1±1.1；group Af, 3.2±1.0, p＜0.001）.

Conclusion：In clinical practice, there was a possibility that Af had a greater and longer-lasting edema-reducing effect compared to Ra；however, with appropriate retreatment, there was no difference in visual and anatomical outcomes at 12 months.