ポリープ状脈絡膜血管症に対する光線力学的療法併用抗血管内皮増殖因子治療後短期における治療成績と再発予測因子

Short-term efficacy and predictors of recurrence of initial photodynamic therapy with anti-vascular endothelial growth factor injections for polypoidal choroidal vasculopathy

要約　目的：ポリープ状脈絡膜血管症（PCV）に対する光線力学的療法（PDT）併用抗血管内皮増殖因子（VEGF）治療後短期における治療成績と再発予測因子の検討。

対象と方法：対象は2017年8月〜2018年8月に九州大学病院眼科で未治療PCVに初回からPDTと抗VEGF薬導入期3回投与を施行し，12か月以上経過観察できた14例14眼。新たな眼底出血，および光干渉断層計で確認された滲出性変化を再発と定義した。PDT併用治療開始から12か月後の時点における治療効果を視力，中心窩網膜厚（CRT），中心窩脈絡膜厚（CCT）に基づいて評価し，再発予測因子を同定するため治療前因子〔既往歴，喫煙歴，ポリープの種類，視力，CRT，CCT，病巣最大径，自発蛍光（FAF）における低蛍光領域〕と再発との関連について検討した。

結果：治療12か月後すべての症例で視力の維持がみられ，CRT，CCTは減少していた。4眼（29％）は治療後12か月以内に再発した。既往歴，喫煙歴，ポリープの種類，視力，CRT，病巣最大径は再発と関連がなかったが，再発群では非再発群に比べて有意に治療前の平均CCTが薄く（非再発群で279±59μm，再発群で196±50μm，p＜0.05），FAFにおける平均低蛍光領域は広かった（非再発群で3.2±1.9μm²，再発群で9.1±5.3μm²，p＜0.05）

結論：PCVに対して初回PDT併用抗VEGF治療を行い，治療開始12か月後すべての症例で視力を維持し，滲出が改善していた。治療前のCCTとFAFでの蛍光領域の広さが，治療後早期の再発予測に有用である可能性が示唆された。

Abstract　Purpose：To report the short-term efficacy and predictors of recurrence of initial photodynamic therapy（PDT）with anti-vascular endothelial growth factor（VEGF）injections for polypoidal choroidal vasculopathy（PCV）.

Cases and method：This retrospective study included 14 eyes of 14 patients of PCV who were treated with PDT-combined therapy with intravitreal anti-VEGF drug injections between August 1, 2017 and August 1, 2018. The patients received PDT and anti-VEGF therapy over 3 times and were observed for 12 months after PDT. Recurrence was assessed based on new bleeding in the fundus and the presence of exudative changes observed in spectral-domain optical coherent tomography. We assessed the efficacy of the PDT-combined therapy by visual acuity, central retinal thickness（CRT）, and central choroidal thickness（CCT）at 12 months after PDT therapy. We also studied the relationship between recurrence and baseline characteristics（patients characteristics, polyp type, visual acuity, CRT, CCT, greatest linear dimension and low fluorescence area in fundus autofluorescence（FAF））.

Results：The visual acuity improved or was maintained with the decrease of CRT and CCT in all patients 12 months after PDT therapy. Four eyes（29％）in 14 eyes showed recurrence during the observation period. Patients' characteristics, polyp type, visual acuity, CRT and greatest linear dimension had no correlation with the recurrence. However, the recurrence group showed thinner CCT（The average CCT was 279±59 μm in non-recurrence group, 196±50 μm in recurrence group. p＜0.05）and larger low fluorescence area in FAF（The average low fluorescence area in FAF was 3.2±1.9 μm² in non-recurrence group, 9.1±5.3 μm² in recurrence group. p＜0.05）before therapy compared with non-recurrence group.

Conclusion：PDT-combined therapy was effective to maintain the visual acuity with subfoveal exudative improvement in PCV patients one year after the therapy. The thin subfoveal choroidal thickness and the large low fluorescence area in FAF at baseline could be risk factors for the recurrence after the PDT-combined therapy for PCV.