ベバシズマブ併用光線力学療法を行った滲出型加齢黄斑変性の4例

Four cases of exudative age-related macular degeneration treated by photodynamic therapy with adjunct use of intravitreal bevacizumab

要約　目的：加齢黄斑変性に対し光線力学療法後にベバシズマブを硝子体内に投与した4症例の報告。症例：病変の最大径が5mmを超える滲出型加齢黄斑変性4例4眼を対象とした。男性3例，女性1例で，年齢は70～79歳であった。4例ともoccult with no classicであった。光線力学療法から5日～2か月後にベバシズマブ1.25mgを硝子体に注入した。結果：術前視力は0.1～0.4であった。6か月後に1例で2段階以上の視力低下があり，3眼では不変であった。初回治療から3か月後に2例，6か月後に3例が再治療を要した。6か月以上の経過中に，1乳頭径以上の網膜出血，網膜剝離，眼内炎などはなかった。結論：加齢黄斑変性に対するベバシズマブを併用する光線力学療法は，無害であり，奏効することがある。

Abstract.　Purpose：To report 4 cases of age-related macular degeneration（AMD）who received photodynamic therapy with adjunct use of intravitreal bevacizmab. Cases and Method：This retrospective study was made on 4 eyes of patients who had occult with no classic type of exudative AMD larger than 5mm in diameter. The series comprised 3 males and one female. The age ranged from 70 to 79 years. Each eye received intravitreal injection of 1.25mg bevacizumab 5 to 60 days after photodynamic therapy. Results：Visual acuity ranged from 0.1 to 0.4 before treatment. Six months later, visual acuity decreased by 2 lines or more in 1 eye and remained unchanged in 3 eyes. Photodynamic therapy had to be repeated in 2 cases 3 months after initial treatment and in 3 cases 6 months after. During the follow-up for 6 months or longer, there was no retinal hemorrhage larger than 1 disc diameter, retinal detachment, or endophthalmitis. Conclusion：Photodynamic therapy with adjunct intravitreal bevacizumab is safe and may be effective for exudative AMD.