加齢黄斑変性における黄斑断面積と視力の関係

Relation between visual acuity and area of section of the macula in age-related macular degeneration

要約　目的：抗VEGF薬で加療した滲出型加齢黄斑変性（AMD）での視力と黄斑断面積との関係の報告。

対象と方法：過去37か月間に抗VEGF薬で加療し，滲出性病変が消失した滲出型AMD 124例124眼を対象とした。男性96例，女性28例で，年齢は50〜92歳，平均74.6歳である。黄斑断面積の算出には光干渉断層計を用い，中心窩を通る縦断面と横断面の面積の平均値を用いた。視力はlogMARとして評価した。

結果：抗VEGF薬で加療し，滲出が消失した滲出型AMDでは，視力と黄斑断面積との間に負の相関があった（p＜0.0001）。治療前に網膜下液がある症例では治療後の視力が有意に良好で（p＜0.05），黄斑浮腫がある症例では治療後の視力が不良であった（p＜0.01）。

結論：抗VEGF薬で加療し，滲出性病変が消失した滲出型AMDでは，黄斑断面積が小さいと視力は有意に不良であった。黄斑浮腫の存在は，滲出型AMDでの視力予後を推定する因子になりうる。

Abstract　Purpose: To report the relation between visual acuity and area of cross section of the macula in age-related macular degeneration（AMD）after successful treatment with vitreal injection of anti-VEGF substance.

Cases and Method: This retrospective study was made on 124 eyes of 124 patients who were treated by us and who responded to anti-VEGF substance for exudative AMD in the past 37 months. The series comprised 96 males and 28 females. The age ranged from 50 to 92 years, average 74.6 years. Optical coherence tomography（OCT）was used to measure the area of cross section of the macula. Visual acuity was evaluated as logMAR.

Results: Area of vertical and horizontal cross section by OCT was averaged for each eye. Visual acuity and area of cross section of the macula showed negative correlation（p＜0.0001）. Eyes with subretinal fluid at the start of treatment showed favorable visual outcome after treatment（p＜0.05）. Eyes with macular edema at the start of treatment resulted in poor visual outcome（p＜0.01）.

Conclusion: Eyes with lesser area of macular cross section resulted in poor visual outcome after anti-VEGF treatment for exudative AMD. Presence of macular edema is one of predictive factors for visual outcome.