光線力学療法施行後早期に著明な視力低下をきたした加齢黄斑変性症例の検討

Early and severe visual impairment after photodynamic therapy for age-related macular degeneration

要約　目的：光線力学療法（PDT）を行った後，早期に顕著な視力低下が起こった症例の検討。対象：PDTを行った加齢黄斑変性（AMD）患者のうち，術前の矯正視力が0.4～0.6の48例48眼を対象とした。男性36例，女性12例であり，年齢は47～87歳（平均72歳）であった。AMDの内訳は，狭義のAMD 15眼，ポリープ状脈絡膜血管症（PCV）28眼，網膜血管腫様増殖5眼であった。結果：PDTから6か月後の視力は，10眼で改善，26眼で不変，12眼で悪化した。7眼（15％）では0.2未満に低下した。この7眼中，2眼がPCV，3眼が脈絡膜新生血管を伴うPCVであった。視力低下の原因は，脈絡膜新生血管の拡大が2眼，瘢痕化が3眼，網膜色素上皮の萎縮が3眼であった。結論：脈絡膜新生血管を伴うPCVでは，PDTを行う際に注意が必要である。

Abstract.　Purpose：To report cases who developed severe visual impairment soon after photodynamic therapy（PDT）for age-related macular degeneration（AMD）. Cases：This retrospective study was made on 48 eyes of 48 cases who had visual acuity from 0.4 to 0.6 and who received PDT for AMD. The cases consisted of 36 males and 12 females. Their age ranged from 47 to 87 years, average 72 years. The AMD was of classical type in 15 eyes, polypoidal choroidal vasculopathy（PCV）in 28 eyes, and retinal angiomatous proliferation in 5 eyes. Results：Six months after PDT, visual acuity improved in 10 eyes, remained unchanged in 26 eyes, and deteriorated in 12 eyes. It decreased below 0.2 in 7 eyes（15％）, of which 2 eyes had PCV and 3 eyes had PCV with choroidal neovascularization. Decrease in visual acuity was due to enlargement of choroidal neovascularization in 2 eyes, scarring in 3 eyes, and atrophy of retinal pigment epithelium in 3 eyes. Conclusion：PDT has to be performed with utmost caution for PCV with choroidal neovascularization.