加齢黄斑変性に対するラニビズマブ投与後における早期中心網膜厚の変化

Changes in central retinal thickness following intravitreal ranibizumab for age-related macular degeneration

要約　目的：加齢黄斑変性（AMD）に対するラニビズマブ硝子体内注射後早期の中心網膜厚と経過の報告。症例：過去15か月間に治療した滲出性AMD 66例66眼を対象とした。男性51例，女性15例で，平均年齢は75.2±7.3歳である。35例が初回治療例，31例が過去に治療歴があった。月1回のラニビズマブ硝子体内注射を計3回行い，治療前後の中心網膜厚を測定した。結果：初回注射から1週間後の中心網膜厚は，初回治療群では減少63％，不変34％，増加3％であり，治療歴がある群では減少68％，不変32％であった。初回治療群での不変または増加例はoccult AMDの症例に多かった。3回目の治療から1か月後の中心網膜厚の平均値は，両群とも初回治療1週間後の中心網膜厚が減少した例でのみ有意に減少していた。結論：加齢黄斑変性（AMD）に対する初回のラニビズマブ硝子体内注射から1週間後の中心網膜厚が不変または増加した症例は，以後のラニビズマブ治療に抵抗性を示す可能性がある。

Abstract.　Purpose：To report early changes in central retinal thickness（CRT）after intravitreal ranibizumab for age-related macular degeneration（AMD）. Cases and Method：This study was made on 66 eyes of 66 cases of AMD treated in the past 15 months. The series comprised 51 males and 15 females. Thirty-five cases were treatment-naïve and 31 cases had received similar treatment before. Affected eyes received intravitreal injection of ranibizumab at one-month interval. CRT was measured before,one day and one week after the first treatment,and one month after the third treatment. Results：CRT one week after the first treatment decreased in 63％,remained unchanged in 34％,and increased in 3％. It decreased in 68％ and remained unchanged in 32％ in eyes with previous treatment. Cases with unchanged or increased CRT were significantly more frequent in occult AMD. CRT one month after the third session of ranibizumab was significantly decreased in eyes that showed decrease in CRT one week after the first session. Conclusion：Eyes that failed to show decreased CRT one week after initial ranibizumab may be resistant to further treatments.