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要約 目的:アフリベルセプト治療抵抗性の滲出型加齢黄斑変性(AMD)に対して光線力学療法(PDT)併用治療を行った12か月成績を検討した。
対象と方法:対象症例は,アフリベルセプト硝子体内投与(IVA)を行い治療効果が乏しいと判断したAMDに対してPDT療法を併用し,12か月間経過観察した滲出型AMDの連続症例22例22眼(平均年齢74.7±7.1歳)。ベースラインおよび12か月後の矯正視力,中心窩網膜厚(CFT),および中心窩脈絡膜厚(CCT),さらに12か月後の滲出性変化消退率,12か月間の硝子体注射投与回数について検討した。
結果:平均logMAR視力はベースライン0.29±0.28,12か月後0.24±0.35(p=0.259)であり,有意な変化はなかった。CFTおよびCCTは有意に減少した。12か月後の滲出性変化消退率は72.7%であった。12か月間の硝子体注射追加投与回数は平均3.6±3.4回,PDTは1回(2眼)または0回(20眼)であった。
結論:アフリベルセプト治療抵抗性のAMDに対するPDT併用療法の12か月後に視力は維持され,滲出性変化は約7割で消退した。
Abstract Purpose:To investigate one-year results of verteporfin photodynamic therapy(PDT)combined with anti-vascular endothelial growth factor(VEGF)agents for neovascular age-related macular degeneration(AMD)with limited response to aflibercept.
Patients and Methods:Medical charts of 22 eyes of 22 patients(17 men and 5 women)with neovascular AMD who were treated with PDT combined with aflibercept for recurrent or persistent disease activity after repetitive administration of aflibercept and followed at least one year were retrospectively reviewed.
Results:The mean age was 74.7±7.1 years. The mean BCVA was similar between the baseline and 1 year after combined PDT. Central foveal thickness and central choroidal thickness measured by optical coherence tomography significantly decreased at 1 year. 72.7% of the cases showed dry macula at one year. In 15 cases treated with pro re nata protocol, mean additional treatment number was 1.6±1.9, and in 7 cases treated with treat and extend protocol, mean additional treatment number was 7.3±2.3. Additional PDT was performed in 2 of 22 cases.
Conclusion:Although the effects may vary with each patient, PDT combined with anti-VEGF agents might be an option for patients after repetitive anti-VEGF treatment.
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