網膜静脈分枝閉塞に伴う黄斑浮腫に対するベバシズマブ連続注射と光凝固併用療法

Treatment of branch retinal vein occlusion with macular edema by repeat intravitreal injection and photocoagulation

要約　目的：網膜静脈分枝閉塞症に併発した黄斑浮腫を，ベバシズマブ硝子体注射と光凝固で治療した結果の報告。対象と方法：3か月以上経過しても黄斑浮腫が軽快しない網膜静脈分枝閉塞11例11眼を対象とした。1か月の間隔でベバシズマブ硝子体注射を3回行ったあと，黄斑格子状光凝固を実施した。網膜厚が20％以上増加した場合と，2段階以上の視力低下があったとき，再治療をした。初回治療から12か月までの成績を前向きに検索した。視力はlogMARとして評価した。結果：平均視力は治療前0.58，12か月後0.16で，有意に改善した（p＜0.05）。網膜厚は治療前558.5μm，12か月後277.8μmで，有意に減少した（p＜0.01）。治療開始から6か月後と12か月後の小数視力は，各7眼（64％）で0.7以上であった。ベバシズマブ硝子体注射の追加回数は平均0.27回，光凝固の追加は平均0.18回であった。結論：ベバシズマブ硝子体注射とこれに続く光凝固は，網膜静脈分枝閉塞症に併発した黄斑浮腫に有効であった。

Abstract.　Purpose：To report the outcome of branch retinal vein occlusion with macular edema by repeat intravitreal injection of bevacizumab and photocoagulation. Cases and Method：This prospective study was made on 11 eyes of 11 cases with branch retinal vein occlusion with macular edema persisting for 3 months or longer. Each eye received 3 sessions of intravitreal bevacizumab at a one-month interval followed by macular grid photocoagulation. The treatment was repeated when central retinal thickness increased by 20％ or more and when visual acuity decreased by 2 lines or more. Cases were followed up for 12 months or longer. Visual acuity was evaluated as logMAR. Results：Visual acuity averaged 0.58 before and 0.16 12 months after treatment. The difference was significant（p＜0.05）. Central retinal thickness averaged 558.5μm before and 277.8μm 12 months after treatment. The difference was significant（p＜0.01）. Visual acuity in digits was 0.7 or over in 7 eyes each（64％）after 6 and 12 months of treatment. Injection of bevacizumab was repeated 0.27 times. Photocoagulation was repeated 0.18 times. Conclusion：Repeat intravitreal injection of bevacizumab followed by macular grid photocoagulation was effective for persistent macular edema in branch retinal occlusion.