ベバシズマブ硝子体注射と光線力学的療法で加療した網膜血管腫の小児例

Retinal hemangioma in a child treated by intravitreal bevacizumab and photodynamic therapy

要約　目的：ベバシズマブ硝子体注射と光線力学的療法（PDT）で加療した網膜血管腫の小児例の報告。症例：11歳女児が乳児期にvon Hippel-Lindau（VHL）病と診断され，眼科的な精査のため受診した。腎囊胞，膵囊胞，小脳血管芽腫があった。祖父と父に網膜血管腫を伴うVHL病があった。所見と経過：矯正視力は左右眼とも1.5であり，両眼の周辺部と左眼黄斑の耳側に網膜血管腫があった。両眼周辺部の網膜血管腫に光凝固を行い，16か月後に左眼にベバシズマブ硝子体注射を行った。さらに1年後に左眼黄斑耳側の血管腫にベバシズマブ硝子体注射とPDTを行った。以後6か月後の現在まで左眼は0.3の視力を維持し，眼底所見の悪化はない。結論：黄斑近くにある網膜血管腫に対し，PDTが有効であった。

Abstract.　Purpose：To report retinal hemangioma in child treated by intravitreal bevacizumab and photodynamic therapy（PDT）. Case：An 11-year-old girl was referred to us for von Hippel-Lindau（VHL）disease. She had been diagnosed with VHL disease during infancy. She had renal cyst, pancreas cyst and cereberal hemangioblastoma. Her father and grandfather had been diagnosed with VHL disease with retinal hemangioma. Findings：Corrected visual acuity was 1.5 in either eye. Both eyes showed hemangioma in the peripheral fundus. The left eye showed, additionally, hemangioma near the macula. Hemangioma in the peripheral retina in both eyes was treated by photocoagulation. The left eye received intravitreal injection of bevacizumab 16 months later. Retinal hemangioma near the macula in the left eye was treated by intravitreal bevacizumab and PDT another one year later. Both eyes have been doing well for 6 months until present. Conclusion：PDT was effective for hemangioma near the macula that could not be treated by photocoagulation.