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要約 目的:滲出型加齢黄斑変性の抗血管内皮増殖因子(VEGF)療法において,維持期再発の早期検出は大きな課題である。本研究の目的は,ポリープ状脈絡膜血管症(PCV)の光干渉断層血管撮影(OCTA)画像の変化から滲出性の再発を予測できるかを検討することである。
対象と方法:対象は関西医科大学附属病院にて未治療PCVに対してアフリベルセプト硝子体内投与による導入期治療後に滲出の再発を認めた症例のうち,再発の1か月前にOCTAを撮影していた4例4眼である。導入期治療前後,滲出再発前後のOCTA画像を後ろ向きに比較検討した。
結果:4例すべてで,滲出再発前に異常血管網およびポリープ状病巣部内において,en face OCTA血流信号に変化を認めた。2例は治療開始後5か月目に滲出が再発したが,その1か月前に異常血管網部に微細な血流信号を認めた。そのうち1例はen face OCTAで,導入期治療後に消失したポリープ状病巣部の血流信号の部分回復を認めた。治療開始後6か月目に滲出が再発した1例は,5か月目に異常血管網部に微細な血流信号とポリープ状病巣部の信号強度の増加を認め,治療開始後8か月目に再発した1例は7か月目に異常血管網部に微細な血流信号を認めた。
結論:PCVに対する抗VEGF療法後の滲出再発前には,異常血管網部に微細な血流信号が出現することがen face OCTAにおいて確認できた。OCTAを頻回に行い,血流信号の変化に着目することで滲出性所見の再発を予測できる可能性がある。
Abstract Purpose:In any treatment regimen with anti-vascular endothelial growth factor(VEGF)therapy for exudative age-related macular degeneration(AMD), it is important to detect early sign of recurrence during the maintenance phase. The purpose of this study is to find out optical coherence tomography angiography(OCTA)findings that can predict a recurrence of exudation in polypoidal choroidal vasculopathy(PCV).
Cases and Methods:Of the eyes with exudative findings reappeared after an initial loading dose of 3 monthly intravitreal injection of aflibercept(IVA)for treatment naïve patients with PCV, 4 eyes in which OCTA were taken one month before recurrence of exudation were evaluated. En face OCTA images were compared before and after induction phase and at time of recurrence.
Results:All the 4 eyes showed changes in blood flow signal before recurrence of exudative findings. In 2 eyes, in which exudative findings reappeared 5 months after the first IVA, tiny vessels in abnormal vascular network were detected one month before recurrence, and in one of them a blood flow signal of polypoidal lesion that disappeared after induction therapy reappeared. In another eye, in which exudative findings reappeared 6 months after the first IVA, tiny vessels in abnormal vascular network and an increase in signal intensity of polypoidal lesion were detected 5 months after the first IVA. In the other eye, in which exudative findings reappeared 8 months after the first IVA, tiny vessels in abnormal vascular network were detected 7 months after the first IVA.
Conclusion:On en face OCTA images, tiny vessels in abnormal vascular network were detected before recurrence of exudative findings after induction anti-VEGF therapy for PCV. By taking OCTA frequently and paying attention to changes in a blood flow signal, it might be possible to predict recurrence of exudative findings in PCV.
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