近視性黄斑変性に対する治療法別視力成績

Visual outcome of subfoveal neovascularization in myopia treated by various methods

要約　目的：近視性黄斑変性に対する治療法別の成績の報告。対象と方法：眼軸長26mm以上または－8D以上の近視に合併した脈絡膜新生血管42例42眼を対象とした。男性8例，女性34例で，年齢は31～81歳（平均61歳）である。治療として新生血管抜去術を11眼，光線力学療法を11眼，部分移動術を13眼，ベバシズマブ硝子体注入を7眼に行った。術後6か月以上の経過を観察した。結果：4群すべてで，術前視力よりも術後最高視力が有意に向上した（p＜0.05）。しかしいずれの群でも，術前視力と最終受診時の視力の間には有意差がなかった。ベバシズマブ注入では，すべて1回の注入で新生血管が退縮した。結論：近視性黄斑変性に対する新生血管抜去術，光線力学療法，部分移動術の視力への効果は，いずれも一過性であった。ベバシズマブ硝子体注入は，手技が簡便で副作用がなく，長期経過の結果が待たれる。

Abstract.　Purpose：To report the outcome of subfoveal neovascularization in myopic eyes after treatment by four different modalities. Cases and Method：This study was made on 42 eyes of 42 patients with choroidal neovascularization. All the eyes had myopia greater than －8 diopters or axial length of 26mm or more. The series comprised 8 males and 34 females. The age ranged from 31 to 81 years,average 61 years. Eleven eyes were treated by surgical removal of neovascularization. Eleven eyes received photodynamic therapy. Thirteen eyes received limited translocation. Seven eyes received vitreal injection of bevacizumab. All the cases were followed up for 6 months or longer. Results：Best corrected visual acuity was higher at the postoperative peak than before treatment in all the 4 groups（p＜0.05）. There was no significant difference between initial and final visual acuity. Intravitreal injection of bevacizumab was followed by resolution of neovascularization after one session. Conclusion：Improvement in visual acuity was temporary after each of four therapeutic modalities for myopic subfoveal neovascularization. Intravitreal injection of bevacizumab may prove useful on long-term basis.