未熟児網膜症に対する抗VEGF療法の治療状況

Status of anti-vascular endothelial growth factor（VEGF） therapy for retinopathy of prematurity

要約　目的：最近3年間の未熟児網膜症（ROP）に対する網膜光凝固術（PC）単独療法と，抗血管内皮増殖因子（VEGF）療法およびPCによる併用療法を行った症例の治療状況を検討する。

方法：対象は2021年1月〜2024年3月に，当院新生児集中治療室（NICU）にて治療した新生児42症例84眼。PC単独療法30症例，ラニビズマブ硝子体内注射（IVR）＋PC療法7症例，アフリベルセプト硝子体内注射（IVA）＋PC療法5症例であった。治療はPCを基本に，重症例には抗VEGF療法を行った。2021年1月〜2023年5月はIVR＋PC療法を施行し，2023年6月以降はIVA＋PC療法を施行した。PC群，IVR＋PC群，IVA＋PC群で，在胎週数，出生体重，国際分類，PC施行回数，硝子体手術（PPV）施行，PC総凝固数，等価球面度数を検討した。

結果：平均在胎週数はPC群26.2±2.0週，IVR＋PC群23.0±0.6週，IVA＋PC群25.2±0.8週であった。IVR＋PC群では有意に出生週数が小さく，初診時にZone Ⅰ網膜症やplus diseaseを認める症例が多かった。PC群では2/60眼，IVR＋PC群では6/14眼，IVA＋PC群では1/10眼でStage Ⅳへ至り，PPVを施行した。Stage Ⅳへ至った症例はPC群，IVR＋PC群では修正1か月以内の発症であったが，IVA＋PC群ではNICU退院後修正4か月時点での発症であった。PPVを施行した症例を除いたPC群，IVR＋PC群，IVA＋PC群では，生後6か月の時点で等価球面度数に有意差はなかった。

結論：IVR＋PC群ではStage Ⅳへ至る症例が多かった。IVR＋PC群ではPC群，IVA＋PC群と比較して重症例が多く，治療開始前の段階で未熟性が高かった影響が考えられた。

Abstract　Purpose：We investigate the treatment status of retinal photocoagulation（PC） alone and combination therapy with anti-vascular endothelial growth factor（VEGF） therapy and PC therapy for retinopathy of prematurity（ROP） in the last 3 years.

Method：The subjects were 84 eyes of 42 neonates treated in our neonatal intensive care unit（NICU） from January 2021 to March 2024：30 patients were treated with PC alone, 7 patients with intravitreal ranibizumab（IVR）＋PC, and 5 patients with intravitreal aflibercept（IVA）＋PC. Therapy was based on retinal photocoagulation（PC）, with anti-VEGF therapy in severe cases；IVR＋PC was performed from January 2021 to May 2023, and IVA＋PC therapy was performed after June 2023；number of weeks of pregnancy, birth weight, international classification, and PC performed in the PC group, IVR＋PC group, and IVA＋PC group, PPV（vitrectomy）, total number of PC coagulations, and equivalent sphericity were examined in the PC, IVR＋PC, and IVA＋PC groups.

Result：The mean number of weeks of gestation was 26.2±2.0 weeks in the PC group, 23.0±0.6 weeks in the IVR＋PC group, and 25.2±0.8 weeks in the IVA＋PC group. The IVR＋PC group had significantly smaller birth weeks, and many patients had Zone Ⅰ retinopathy or plus disease at the initial visit. 2/60 eyes in the PC group, 6/14 eyes in the IVR＋PC group, and 1/10 eyes in the IVA＋PC group developed Stage Ⅳ and were treated with PPV. PC group and IVR＋PC group developed the disease within 1 month, while IVA＋PC group developed the disease at 4 months after discharge from the NICU. There was no significant difference in equivalent sphericity at 6 months of age among the PC, IVR＋PC, and IVA＋PC groups, excluding the patients who underwent vitrectomy.

Conclusion：More patients in the IVR＋PC group progressed to Stage Ⅳ. The IVR＋PC group had more severe cases than the PC and IVA＋PC groups, which may have had an effect of high immaturity at the stage before the start of treatment.