重症未熟児網膜症に対してベバシズマブ硝子体注射と網膜光凝固を併用した2症例

Photocoagulation and intravitreal injection of bevacizumab in two cases of severe retinopathy of prematurity

要約　目的：光凝固とベバシズマブ硝子体注射で加療した重症未熟児網膜症（APROP）の2症例の報告。症例：1例は在胎24週で出生し，生下時体重665gの女児で，posterior zone 2 stage 3 plusの未熟児網膜症があり，2回の光凝固を受けたが改善せず，修正35週で当科に転院した。他の1例は在胎22週で出生し，生下時体重499gの男児で，zone 1 stage 2 plusの未熟児網膜症があり，APROPと診断された。硝子体混濁が強く，光凝固は困難と判断され，当科に転院した。結果：1例には修正35週に両眼に光凝固とベバシズマブ硝子体注射を行い，翌日から増殖性病変は軽快した。他の1例には修正32週に両眼にベバシズマブ硝子体注射を行った。4週後に再増殖があり，その翌週に光凝固を行い，網膜症の活動性が低下した。結論：ベバシズマブ硝子体注射がAPROPに対する治療の選択肢になる。

Abstract.　Purpose：To report 2 case of severe retinopathy of prematurity（ROP）treated by photocoagulation and intravitreal injection of bevacizumab. Cases：One was a girl born at the gestational 24 weeks with birthweight of 665 g. She showed posterior zone 2 stage 3 plus ROP. Two sessions of photocoagulation failed to prevent progression of ROP. She was referred to us at 35 weeks. The other was a boy born at the gestational 22 weeks with birthweight of 499 g. He showed zone 1 stage 2 plus ROP. Photocoagulation was not performed due to vitreous opacity. He was referred to us at 32 weeks. Results：The girl received photocoagulation and bevacizumab injection in both eyes at 35 weeks. Proliferative fundus lesions started to decrease from the next day on. The boy received bevacizumab injection in both eyes at 32 weeks. Proliferative lesions recurred 4 weeks later. Photocoagulation was performed the following week, resulting in decreased activity of ROP. Conclusion：These cases illustrate that intraviteal injection of bevacizumab may be effective for severe ROP.