網膜静脈分枝閉塞症に併発する黄斑浮腫に対する組織プラスミノゲン活性化因子の硝子体内投与

Intravitreal injection of tissue plasminogen activator for macular edema in branch retinal vein occlusion

要約　目的：網膜静脈分枝閉塞症に併発した黄斑浮腫に対する組織プラスミノゲン活性化因子の硝子体内投与の効果と安全性の評価。対象と方法：網膜静脈分枝閉塞症18例18眼を対象とした。男性9例，女性9例であり，年齢は55～77歳（平均64歳）であった。13例が1か月以内の発症であった。組織プラスミノゲン活性化因子4万国際単位を硝子体腔に注入した。視力はlogMARとして評価した。結果：視力の平均値は，術前0.46，術後1か月0.23，3か月0.18，6か月0.17，12か月0.11であり，いずれも有意に改善した（p＜0.01）。中心窩厚（μm）の平均値は術前528，術後1か月383，3か月336，6か月302，12か月206と，いずれも有意に減少した（p＜0.01）。術後に一過性の高眼圧1例，黄斑前膜2眼，再閉塞1眼，白内障1眼が生じた。結論：網膜静脈分枝閉塞症に併発した黄斑浮腫に対し，組織プラスミノゲン活性化因子の硝子体内投与は，12か月間は有効で，おおむね安全である。

Abstract.　Purpose：To evaluate the efficacy and safety of intravitreal injection of tissue plasminogen activator for macular edema secondary to branch retinal vein occlusion（BRVO）. Cases and Method：This study was made on 18 eyes of 18 patients with BRVO. The series comprised 9 males and 9 females. The age ranged from 55 to 77 years, average 64 years. BRVO had been present for 1 month or less in 13 cases. Each eye received intravitreal injection of 4IU of tissue plasmsinogen activator. Visual acuity was evaluated in terms of logMAR. Results：Averaged visual acuity was 0.46 before treatment, 0.23 after 1 month, 0.18 after 3 months, 0.17 after 6 months, and 0.11 after 12 months. The differences were significant（p＜0.01）. Averaged foveal thickness was 528μm before treatment, 383μm after 1 month, 336μm after 3 months, 302μm after 6 months, and 206μm after 12 months. The differences were significant（p＜0.01）. The treatment was followed by transient ocular hypertension in one eye, epiretinal membrane in 2 eyes, reocclusion in 1 eye, and cataract in 1 eye. Conclusion：Intravitreal injection of tissue plasminogen activator was effective and safe for macular edema secondary to BRVO during observation for 12 months.