網膜血管腫状増殖に対するトリアムシノロンアセトニド併用光線力学的療法

Combined posterior juxtascleral triamcinolone acetonide and photodynamic therapy for retinal angiomatous proliferation

要約　目的：網膜血管腫状増殖（retinal angiomatous proliferation：RAP）に対するトリアムシノロンアセトニド（triamcinolone acetonide：TA）併用光線力学的療法（photodynamic therapy：PDT）の効果の検討。対象と方法：TA後部テノン囊下注入併用PDTを施行したRAP 6例7眼について，治療後3か月の視力，滲出性変化を評価した。Yannuzziらの病期分類では，stage Ⅰが1眼，stage Ⅱ（retinal pigment epithelial detachment：PEDなし）が3眼，stage Ⅱ（PEDあり）が2眼，stage Ⅲが1眼であった。結果：視力は治療前0.07～0.5（平均0.26）に対し，治療3か月後0.09～0.6（平均0.33）と軽度の改善がみられた。滲出性変化は，stage Ⅰ，stage Ⅱ（PEDなし）の4眼はすべて改善した。Stage Ⅱ（PEDあり）の2眼では，1眼は改善したが，1眼では一過性の改善しか得られなかった。Stage Ⅲの1眼では滲出性変化が改善し，脈絡膜新生血管が閉塞した。結論：RAPに対するTA併用PDTは有効性が高い。

Abstract.　Purpose：To evaluate the efficacy of combined treatment of photodynamic therapy（PDT）and triamcinolone acetonide（TA）for retinal angiomatous proliferation（RAP）. Patients and Methods：We evaluated visual acuity and exudative change during post-therapeutic 3 months in 7 eyes of 6 patients with RAP who received combined treatment of PDT and posterior juxtascleral injection of TA. These 7 eyes consisted of one eye at stage Ⅰ, 3 eyes at stage Ⅱ without retinal pigment epithelial detachment（PED）, 2 eyes at stage Ⅱ with PED and one eye at stage Ⅲ. Results：The mean pre-therapeutic visual acuity was 0.26（range, 0.07-0.5）, and the mean post-therapeutic visual acuity was 0.33（range, 0.09-0.6）. All of four eyes at stage Ⅰ and stage Ⅱ without PED showed decreased exudative change. Among the 2 eyes at stage Ⅱ with PED, exudative change was decreased in one eyes. In the remaining one eye, exudative change was temporarily diminished but recurred later. In one eye at stage Ⅲ, exudative change was decreased and choroidal neovascularization was closed. Conclusion：Combined treatment of PDT and TA for RAP appeared effective.