網膜中心静脈閉塞症に伴う黄斑浮腫に対するアフリベルセプト硝子体注射の長期成績

Long-term outcome of intravitreal aflibercept for macular edema secondary to central retinal vein occlusion

要約　目的：網膜中心静脈閉塞症に伴う黄斑浮腫に対するアフリベルセプト硝子体注射の長期成績の報告。

対象と方法：網膜中心静脈閉塞症に伴う黄斑浮腫に対してアフリベルセプト硝子体注射を行った17例17眼の経過を診療録から検索した。全例が日本人で，男性11例，女性6例であり，年齢は64〜76歳，平均70歳である。10眼が初回治療，7眼がベバシズマブまたはラニビズマブからの切り替えである。視力はlogMARとして評価した。

結果：治療開始前の矯正視力は，平均0.53±0.39であり，以後の18か月間に有意な変化はなかった。治療開始前の網膜厚は，平均673.7±258.0μmであり，6，12，18か月後にはそれぞれ有意に減少した（p＜0.01）。経過中に全例で黄斑浮腫が再発し，その64％が3か月以内であった。12か月間に平均4.9回，18か月間に平均6.9回の硝子体注射が行われた。

結論：アフリベルセプト硝子体注射は，網膜中心静脈閉塞症に伴う黄斑浮腫を軽減させた。黄斑浮腫の再発が多く，複数回の追加注射が必要であった。

Abstract　Purpose: To report the long-term outcome of intravitreal injection of aflibercept for macular edema secondary to central retinal vein occlusion.

Cases and Method: This retrospective study was made on 17 eyes of 17 Japanese patients of central retinal vein occlusion who received intravitreal aflibercept for macular edema and who were followed up for 18 months or longer. The series comprised 11 males and 6 females. The age ranged from 64 to 76 years, average 70 years. Ten cases received anti-VEGF therapy for the first time and 7 cases were switched to aflibercept from other anti-VEGF drugs. Visual acuity was evaluated as logMAR.

Results: At the start of treatment, visual acuity averaged 0.53±0.39 and central retinal thickness averaged 673.7±258 μm. There was no significant change in visual acuity during 18 months of treatment. Central retinal thickness decreased significantly at 6, 12 and 18 months of treatment（p＜0.01）. All the cases showed recurrence of macular edema, necessitating additional aflibercept treatment. Macular edema recurred within 3 months of treatment in 64％ of cases. The session of additional treatment averaged 4.9 times during 12 months and 6.9 times during 18 months.

Conclusion: Intravitreal injection of aflibercept was followed by reduction of macular edema secondary to central retinal vein occlusion. Multiple sessions were needed due to recurrence of macular edema.