ラニビズマブからアフリベルセプトへ変更した加齢黄斑変性の検討

Outcome after switching from intravitreal ranibizumab to aflibercept for age-related macular degeneration

要約　目的：加齢黄斑変性（AMD）のラニビズマブ硝子体注射（IVR）難治例に対するアフリベルセプト硝子体注射（IVA）変更後の短期成績の報告。対象と方法：対象はIVRからIVAに変更したAMD19例20眼（男性14例，女性5例，平均年齢75.4歳）で，初回IVA後6か月の視力と光干渉断層計（OCT）所見の変化を検討した。結果：IVA治療前後の平均視力は不変であった。OCT所見による有効率と再発率は，黄斑浮腫について100％と83％，網膜下液は100％と57％，網膜色素上皮剝離は86％と43％であった。結論：IVRからIVAへ変更した後は，形態的な改善例が多いが，短期に再発する例もある。

Abstract.　Purpose：To report the outcome after switching from ranibizumab to aflibercept in eyes with age-related macular degeneration（AMD）. Cases and Method：This retrospective study was made on 20 eyes of 19 cases with AMD. The series comprised 15 male and 5 female eyes. The age ranged from 64 to 82 years, average 75.4 years. Polypoidal choroidal vasculopathy was present in 15 eyes and typical AMD in 5 eyes. All the eyes had received an average of 8.8 sessions of intravitreal ranibizumab in the foregoing 7 to 43 months, average 26 months. Cases were evaluated regarding visual acuity and findings by optical coherence tomography（OCT）6 months after switching. Results：There was no change in visual acuity after switching. By OCT evaluation, foveal thickness remained the same, macular edema decreased in 100％, subretinal fluid decreased in 100％ and detachment of retinal pigment epithelium decreased in 86％ of eyes. Macular edema recurred in 83％, subretinal fluid in 57％ and detachment of retinal pigment epithelium in 43％ of the eyes. Conclusion：Visual acuity failed to improve 6 months after switching from intravitreal ranibizumab to aflibercept in eyes with AMD. OCT showed frequent morphological improvement of macular lesions with occasional recurrences.