光線力学療法の直後に視力低下した加齢黄斑変性症例の検討

Review of cases with impaired visual acuity immediately after photodynamic therapy for age-related macular degeneration

要約　目的：加齢黄斑変性に対して光線力学療法を行い，その直後に視力が低下した症例の報告。対象：過去23か月間に光線力学療法を行った加齢黄斑変性189例191眼のうち，その1週間以内に矯正視力がlogMAR換算で0.2以上低下した18例19眼（9.7％）を対象とした。結果：平均logMAR視力は，加療前0.65，1週間後1.11，3か月後0.82で，7眼では加療前の視力以下であった。視力低下の原因は，照射部位の脈絡膜循環障害10眼，網膜下液の増加9眼，出血増加7眼，広範な黄斑下血腫1眼であった。結論：光線力学療法を行った加齢黄斑変性で，その直後に急激な視力低下が約10％の症例で起こった。視力低下は一過性のことが多いが，永続する例があり，注意が必要である。

Abstract.　Purpose：To report cases of impaired visual acuity that developed immediately after photodynamic therapy（PDT）for age-related macular degeneration（AMD）. Cases：This retrospective study was made on 191 eyes of 189 cases of AMD who received PDT for AMD during a 23-month period. Within one week after PDT, logMAR visual acuity decreased by 0.2 or more in 19 eyes of 18 cases（9.7％）. Results：The logMAR visual acuity in the 19 eyes averaged 0.65 before PDT, 1.11 one week after PDT, and 0.82 3 months after PDT. The final visual acuity was lower than the pretreatment level in 7 eyes. Decrease in visual acuity was due to impaired choroidal circulation at the site of PDT in 10 eyes, increase of susbretinal fluid in 9 eyes, increased hemorrhage in 7 eyes, and submacular hemorrhage in 1 eye. Conclusion：Visual acuity was in about 10％ of eyes that received PDT for AMD. Due attention is needed as visual acuity may be impaired permanently.