トリアムシノロンアセトニド併用光線力学療法が視感度と脈絡膜循環に与える影響

Effect of adjunctive use of triamcinolone on visual sensitivity and choroidal circulation after photodynamic therapy

要約　背景：光線力学療法とトリアムシノロンの併用が有用である可能性がある一方，トリアムシノロンの網膜色素上皮への毒性と脈絡膜循環障害の問題がある。目的：加齢黄斑変性に対する光線力学療法を，単独またはトリアムシノロン併用で行ったときの，視感度と脈絡膜循環に及ぼす影響の報告。対象と方法：広義の加齢黄斑変性105例106眼を対象とした。57眼には光線力学療法のみ，49眼にはこれにトリアムシノロンのテノン囊下注射を行った。全例を3か月以上経過を追った。視力はlogMARで評価し，0.2以上の変化を有意とした。脈絡膜循環はインドシアニングリーン蛍光造影で検索した。結果：視力維持率，Humphrey視野計によるMD値の変化，照射部低蛍光の出現頻度は，両群間に差がなかった。再発に対する再治療は，トリアムシノロン併用群で有意に少なかった。結論：加齢黄斑変性に対する初回光線力学療法で，トリアムシノロンのテノン囊下投与が，治療後の視感度と脈絡膜循環に与える影響は少ない。

Abstract.　Background：Triamcinolone has been reported to enhance the effect of photodynamic therapy. Triamcinolone may damage the retinal pigment epithelium and choroidal circulation. Purpose：To report changes in visual sensitivity and choroidal circulation after photodynamic therapy with or without adjunctive triamcinolone. Cases and Method：This study was made on 106 eyes of age-related macular degeneration, of which 57 eyes received photodynamic therapy alone. The other 49 eyes received additional subtenon injection of triamcinolone. Cases were followed up for 3 months or longer. Visual acuity was evaluated in terms of logMAR, changes by 0.2 or more were regarded as significant. Results：There were no significant differences between the two groups regarding visual outcome, changes in MD value measured by Humphrey perimetry, or incidence of hypoperfusion in irradiated area. Incidence of cases necessitating additional treatment for recurrence was significantly lower in triamcinolone group. Conclusion：Adjunctive use of triamcinolone does not significantly influence the outcome of photodynamic therapy for age-related macular degeneration.