片眼発症の滲出型加齢黄斑変性治療中に僚眼にも発症した患者の臨床的特徴

Characteristics of patients who developed neovascular age-related macular degeneration in the fellow eye during treatment for unilateral neovascular age-related macular degeneration

要約　目的：片眼発症の滲出型加齢黄斑変性（AMD）の治療中に僚眼にも滲出型AMDを発症した患者の臨床的特徴の検討。

対象と方法：2009年4月〜2019年3月に名古屋市立大学病院で片眼の滲出型AMDと診断され，血管内皮増殖因子阻害療法または光線力学的療法を開始した症例のうち，経過観察中に僚眼にも滲出型AMDを発症し，治療を開始した患者33例の視力，中心網膜厚，眼底所見，眼底自発蛍光，網膜光干渉断層像を後ろ向きに検討した。

結果：検討した33例は，男性24例，女性9例，平均年齢76.0歳。僚眼の病型は典型AMD 11例，ポリープ状脈絡膜血管症15例，網膜血管腫状増殖（RAP）7例であった。僚眼のlogMAR視力は初発眼発症時0.02，僚眼発症時0.23，僚眼発症1年後0.24，最終受診時0.42であり，僚眼発症1年後（p＜0.05），最終受診時（p＜0.01）において悪化していた。また，初発眼発症時に軟性ドルーゼンを認めた症例および網膜色素上皮（RPE）色素異常を認めた症例は，認めなかった症例と比較して最終視力が悪化していた（p＜0.01，p＜0.05）。RAPでは7例いずれも軟性ドルーゼン，RPE色素異常を認めた。

結論：滲出型AMD加療中の僚眼は早期に滲出型AMDが発見され治療されるが，長期的に視力の改善が得られにくい可能性があるため，滲出型AMD加療中の僚眼に軟性ドルーゼンやRPE色素異常を伴う場合は，視力が良好でも注意深い観察が必要である。

Abstract　Purpose：To investigate the characteristics of eyes with bilateral neovascular age-related macular degeneration（NV-AMD）, in which the fellow eye developed NV-AMD during treatment of the first affected eye.

Patients and methods：This retrospective review included 33 patients（24 men, 9 women；mean age, 76.0±6.8 years）who developed NV-AMD in the fellow eye during treatment with anti-vascular endothelial growth factor therapy or photodynamic therapy at Nagoya City University Hospital from April 2009 to March 2019 in the first affected eye. The logarithm of the minimum angle of resolution best-corrected visual acuity（BCVA）and the central retinal thickness on optical coherence tomography（OCT）were assessed. The characteristics of the fundus in the fellow eye also were assessed by fundus autofluorescence（FAF）, fundus photography, and OCT.

Results：The fellow eyes that developed NV-AMD were diagnosed with typical AMD in 11 patients, polypoidal choroidal vasculopathy in 15 patients, and retinal angiomatous proliferation（RAP）in seven patients. The mean BCVA in the fellow eye was 0.02 at the onset of NV-AMD in the first affected eye, 0.23 at the onset of NV-AMD in the fellow eye, 0.24 1 year after the onset of NV-AMD in the fellow eye, and 0.42 at the last visit. The BCVA in the fellow eye worsened at 1 year after the onset of the NV-AMD in the fellow eye（p＜0.05）, and at the last visit（p＜0.01）. The mean BCVA in the fellow eye with soft drusen or retinal pigment epithelium（RPE）pigment abnormalities at the onset of NV-AMD in the first affected eye was significantly worse compared to that in the fellow eye without soft drusen or RPE pigment abnormalities at the last visit（p＜0.01, p＜0.05）. All patients with RAP had soft drusen and RPE pigment abnormalities.

Conclusions：Patients with NV-AMD who also developed this disease in the fellow eye may have a poor prognosis despite both early detection and intensive treatment. In the fellow eye of NV-AMD patients with soft drusen, RPE pigment abnormalities or abnormal FAF should be followed carefully even if the eye maintains better VA.