加齢黄斑変性に対する光線力学療法後に生じた脈絡膜循環障害の視力への影響

Influence on visual acuity by choroidal ischemia following photodynamic therapy for age-related macular degeneration

要約　目的：加齢黄斑変性に対する光線力学療法後に起こる脈絡膜循環障害の検討。対象と方法：加齢黄斑変性に対し，初回治療として光線力学療法を行い，1回の照射で脈絡膜新生血管が鎮静化し，6か月以上の経過が追えた45例46眼を対象とした。男性35眼，女性11眼であり，年齢は50～86歳（平均73歳）である。照射の3か月後にインドシアニングリーン蛍光造影を行い，照射部と一致する低蛍光を示す低蛍光群と，そうでない非低蛍光群に分けた。視力はlogMARで評価した。結果：低蛍光群が18眼（39％），非低蛍光群が28眼（61％）であった。最終矯正視力の0.3以上の低下が，低蛍光群中5眼（28％），非低蛍光群中1眼（4％）にあった。2群間には有意差があった（p＜0.05）。結論：加齢黄斑変性に対する光線力学療法では，脈絡膜循環障害が続発し視力障害が起こる可能性がある。

Abstract.　Purpose：To report and discuss impaired choroidal circulation after photodynamic therapy for age-related macular degeneration（AMD）. Cases and Method：This study was made on 46 eyes of 45 patients who received photodynamic therapy for AMD and who were followed up for 6 months or longer. The series comprised 35 male and 11 female eyes. The age ranged from 50 to 86 years, average 73 years. Indocyanine green angiography was performed 3 months after treatment. Eyes were assigned to hypofluoresent group when the treated area showed hypofluorescence. When otherwise, eyes were assigned to nonhypofluorescent group. Visual acuity was evaluated as logMAR. Results：Eighteen eyes（39％）were assigned to hypofluorescent group and the other 28 eyes（61％）to nonhypoflurescent group. Final visual acuity decreased by 0.3 or more in 5 eyes（28％）in the former group and in one eye（4％）in the latter. The difference was significant（p＜0.05）. Conclusion：There is a possibility that visual acuity may be impaired secondary to choroidal ischemia following photodynamic therapy for AMD.