網膜静脈分枝閉塞症に対してラニビズマブ硝子体注射後の黄斑円孔が自然閉鎖した1例

A case of full-thickness macular hole formation and spontaneous closure during intravitreal ranibizumab therapy for branch retinal vein occlusion

要約　目的：網膜静脈分枝閉塞症に伴う黄斑浮腫に対してラニビズマブ硝子体注射後に黄斑円孔をきたし，経過観察によって自然閉鎖した1例を経験したので報告する。

症例：62歳，女性。1か月以上前からの右歪視を主訴に近医受診。右網膜静脈分枝閉塞症に伴う黄斑浮腫に対しラニビズマブ（ルセンティス^®）硝子体注射を34G針にて施行。投与後1か月の網膜光干渉断層計（OCT）で全層黄斑円孔が確認され当院紹介となった。当院初診時の右眼矯正小数視力は（0.3）であった。黄斑円孔確認後2週間で黄斑円孔の一部に架橋構造を伴った自然閉鎖傾向を認め，右眼矯正視力は（0.4）と改善傾向であったため経過観察とした。さらに2週間後には右眼矯正視力が（0.8）と改善し，初診8か月後時点でもOCTでは黄斑円孔の自然閉鎖は維持されていた。

結論：網膜静脈分枝閉塞症に対するラニビズマブ硝子体注射治療は症例数が多く本邦において広く行われているものの，稀ではあるが経過中に全層黄斑円孔が起こりうる点，さらには経過観察により自然閉鎖しうる点には留意が必要である。

Abstract　Purpose：To report a case of full-thickness macular hole formation and its spontaneous closure during intravitreal ranibizumab therapy for macular edema resulting from branch retinal vein occlusion.

Case：A 62-year-old woman noticed metamorphopsia in the right eye, which had been present for over a month. She was referred to a local ophthalmologist and was diagnosed with macular edema due to branch retinal vein occlusion. She was treated with intravitreal ranibizumab（Lucentis^®）using a 34 G needle. One month later, optical coherence tomography（OCT）showed the formation of a full-thickness macular hole, and she was referred to Nagoya University Hospital. At her initial visit to Nagoya University Hospital, her decimal best-corrected visual acuity（BCVA）was 0.3 in the right eye. Two weeks after the initial visit, during a follow-up appointment, OCT showed partial spontaneous closure of the macular hole, and her decimal BCVA was 0.4 in the right eye. One month after the initial visit, her decimal BCVA further improved to 0.8 in the right eye, and the spontaneous closure of the macular hole was also maintained eight months after the initial visit.

Conclusion：Intravitreal injections of anti-vascular endothelial growth factor agents for branch retinal vein occlusion are widely used in Japan. Although rare, it should be noted that processes such as full-thickness macular hole formation and spontaneous closure with follow-up may take place, as in this case.