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要約 目的:網膜静脈閉塞症(RVO)に伴う黄斑浮腫(ME)(RVO-ME)に対するラニビズマブBS硝子体内注射(IVRBS)の3か月成績について検討した。
対象と方法:順天堂大学医学部附属浦安病院でRVO-MEに対しIVRBSを行った症例を対象とした。注射レジメンは導入期に1回IVRBSを行い,1週後,以後1か月ごとに受診とした。再投与基準は中心窩網膜厚(CMT)が300μmを超えてMEが再発・遷延した際とした。初回注入後3か月間のlogMAR視力,CMTの推移,再発までの期間について網膜静脈分枝閉塞症(BRVO),網膜中心静脈閉塞症(CRVO)それぞれにおいて診療録を基に後ろ向きに検討した。
結果:対象はBRVO 9例9眼(年齢71.4±5.9歳),CRVO 9例9眼(年齢66.6±20.2歳),ベースライン時の視力とCMTはBRVOでlogMAR 0.47±0.36,479.8±127.7μm,CRVOでlogMAR 0.46±0.40,662.8±279.5μmであった。3か月時点ではBRVOでlogMAR 0.19±0.19,235.7±68.7μmと注入前と比較しいずれも有意に改善した(p=0.014,p=0.0078)。CRVOではlogMAR 0.40±0.40と改善はなく,438.3±215.1μmとCMTは有意に改善した。また1か月以内の再発はBRVO 0/9眼,CRVO 4/9眼で有意にBRVOで少なかった(p=0.04)。
結論:IVRBSはBRVOに対してはCRVOと比べて初回注射後1か月以内の再発が少なく,短期的に効果があることが示唆された。また,視力において初回注射後3か月の時点でBRVOでは改善を認めたが,CRVOでは改善なくより長期の検討が必要である。
Abstract Purpose:To evaluate the 3-month outcomes of intravitreal injection of Ranibizumab BS(IVRBS) for macular edema associated with retinal vein occlusion(RVO-ME).
Subjects and Methods:This study included patients treated with IVRBS for RVO-ME at Juntendo University Urayasu Hospital. The injection regimen comprised one initial IVRBS, followed by follow-up visits after one week and monthly thereafter. Re-treatment was performed when the central macular thickness(CMT) exceeded 300 μm and macular edema(ME) recurred or persisted. A retrospective review was conducted using medical records to assess logMAR visual acuity, CMT changes, and time to recurrence of Branch Retinal Vein Occlusion(BRVO) and Central Retinal Vein Occlusion(CRVO) over 3 months following the first injection.
Results:The study included 9 eyes of 9 patients with BRVO(mean age 71.4±5.9 years) and 9 eyes of 9 patients with CRVO(mean age 66.6±20.2 years). Baseline visual acuity and CMT were BRVO at logMAR 0.47±0.36 and 479.8±127.7 μm and CRVO logMAR 0.46±0.40 and 662.8±279.5 μm. At 3 months after the initial injection, for BRVO, visual acuity improved to 0.19±0.19, and CMT decreased to 235.7±68.7 μm, indicating significant improvement compared to baseline(p=0.014, p=0.0078). For CRVO, visual acuity was 0.40±0.40, and CMT was 438.3±215.1 μm. Recurrence within 1 month occurred in 0/9 eyes with BRVO and 4/9 eyes with CRVO, with a significant difference between the two groups(p=0.04).
Conclusion:IVRBS was associated with fewer recurrences within 1 month after the first injection in BRVO compared to that observed for CRVO, suggesting that IVRBS is effective for the short-term treatment of BRVO. Visual acuity improved at 3 months after the first injection in BRVO, but not in CRVO, suggesting the need for a longer-term study.

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