滲出型加齢黄斑変性の網膜色素上皮下病巣に対するアフリベルセプト単回投与の効果

Outcome of exudative age-related macular degeneration with sub-retinal pigment epithelial lesion after a single session of intravitreal aflibercept

要約　目的：ラニビズマブ硝子体投与に無反応または再発した加齢黄斑変性（AMD）にアフリベルセプト硝子体投与を行った症例の報告。対象と方法：滲出型加齢黄斑変性74例75眼を対象とした。男性59眼，女性16眼で，年齢は57～88歳，平均73歳である。過去にラニビズマブを1～17回，平均5.8回の投与を受け，67眼が再燃，8眼が耐性と判断された。34眼がⅠ型AMD，41眼がポリープ状脈絡膜血管症（PCV）であった。各眼にアフリベルセプト硝子体投与を行い，その1か月後に眼底所見を光干渉断層計（OCT）で検索した。結果：中心窩網膜厚は343μmから201μmに，Ⅰ型での脈絡膜新生血管厚は90μmから60μmに，PCVでの病巣厚は359μmから239μmに，網膜色素上皮剝離の高さは360μmから203μmに，いずれも有意に減少した。結論：ラニビズマブ硝子体投与に無反応，または再発したAMDに対し，アフリベルセプト硝子体投与は有効であった。

Abstract.　Purpose：To report the outcome of intravitreal aflibercept for age-related macular degeneration（AMD）that failed to respond to intravitreal ranibizumab. Cases and Method：This retrospective study was made on 75 eyes of 74 cases of exudative AMD. The series comprised 59 male and 16 female eyes. The age ranged from 57 to 88 years, average 73 years. Each case had received one to 17, average 5.8 sessions of intravitreal ranibizumab. AMD recurred in 67 eyes and proved refractory in 8 eyes. There were 34 eyes of type Ⅰ AMD and 41 eyes of polypoidal choroidal vasculopathy（PCV）. Each case received one session of intravitreal aflibercept. Fundus lesions were examined by optical coherence tomography（OCT）before and one month after treatment. Results：Foveal thickness decreased from 343μm to 201μm, thickness of newly formed vessels in type Ⅰ AMD from 90μm to 60μm, thickness of fundus lesion in PCV from 359μm to 239μm, and height of detached retinal pigment epithelium from 360μm to 203μm. All the changes were significant. Conclusion：Intravitreal aflibercept was effective for AMD that failed to respond to intravitreal ranibizumab.