加齢黄斑変性症患者の角膜に対するラニビズマブとアフリベセプトの反復体外注射の効果

Effect of Repeated Intravitreal Ranibizumab and Aflibercept Injections on the Cornea in Patients with Age-Related Macular Degeneration.

• Beata Urban
• Magdalena Szwabowicz
• Alina Bakunowicz-Łazarczyk

抄録

目的:

加齢黄斑変性症（AMD）患者の角膜内皮および中心角膜厚（CCT）に対するラニビズマブの反復体外注射（RI）およびアフリベセプトの反復投与（AI）の効果を評価すること。

Purpose: To assess the effect of repeated intravitreal ranibizumab injections (RI) and aflibercept injections (AI) on the corneal endothelium and central corneal thickness (CCT) in patients with age-related macular degeneration (AMD).

材料と方法:

レトロスペクティブ研究では、52歳から93歳までの106人の患者110眼を解析した。50眼はRIのみの治療（I群）、60眼はAIのみの治療（II群）とした。各患者は、ラニビズマブ0.5mgを1ヶ月に1回、またはアフリベルセプト2mgを3ヶ月に1回、体外注射を受けた。各患者は全観察期間中に3回のみ注射を受けた。角膜分析は、鏡面顕微鏡を用いて行った。検査は、初回治療前、各注射後、および初回注射後6ヶ月後に実施した。分析には、角膜内皮細胞密度（ECD）、六角細胞率（％ Hex）、変動係数（CoV）、CCTが含まれていた。

Materials and Methods: In the retrospective study, 110 eyes of 106 patients, aged 52 to 93 years, were analyzed. Fifty eyes were treated only with RI (I group), and 60 eyes were treated only with AI (II group). Every patient received one intravitreal injection of 0.5 mg of ranibizumab once a month or 2 mg of aflibercept for 3 subsequent months. Each patient received only 3 injections during the whole observation period. Corneal analysis was obtained with the specular microscope. Examinations were performed before initial treatment, after each injection, and 6 months after the first injection. Analysis included corneal endothelial cell density (ECD), hexagonal cell percentage (% Hex), coefficient of variation (CoV), and CCT.

結果:

抗VEGF剤の種類にかかわらず、統計学的に有意なECDの損失があった。I群の平均ECD値は、RI前2397±459 cells/mm、1回目のRI後2389±459 cells/mm、2回目のRI後2386±467 cells/mm、3回目のRI後2378±475 cells/mm、6ヶ月後2357±460 cells/mmであった。II群の平均ECD値は、治療前2448±493 cells/mm、1回目のRI後2456±498 cells/mm、2回目のRI後2426±496 cells/mm、3回目のRI後2402±488 cells/mm、1回目のRI後2348±473 cells/mmであった。RIを投与した群と比較して、AIを投与した群では、各測定点でECDの損失が大きくなっていた。六角細胞の割合は両群で減少した。両群ともに多血症がわずかに増加していた。ラニビズマブはCCTをわずかに増加させたが、アフリベセプト群ではCCTは変化しなかった。

Results: There was a statistically significant ECD loss, regardless of the type of the anti-VEGF agent. The mean ECD value in the I group was 2397 ± 459 cells/mm before RI, 2389 ± 459 cells/mm after the first RI, 2386 ± 467 cells/mm after the second RI, 2378 ± 475 cells/mm after the third RI, and 2357 ± 460 cells/mm 6 months after the first RI. The mean ECD value in the II group was 2448 ± 493 cells/mm before treatment, 2456 ± 498 cells/mm after the first AI, 2426 ± 496 cells/mm after the second AI, 2402 ± 488 cells/mm after the third AI, and 2348 ± 473 cells/mm 6 months after the first AI. In comparison with the group treated with RI, the group treated with AI presented a greater ECD loss at each measuring point. The percentage of hexagonal cells was decreased in both groups. There was a slight increase in polymegathism in both treated groups. Ranibizumab proved to cause a small increase in CCT, while CCT remained unchanged in the aflibercept group.

結論:

ラニビズマブ0.5mgまたはアフリベセプト2mgの反復的な体外注射は角膜内皮の形態に影響を与えますが、CCTには影響を与えませんでした。

Conclusions: Repeated intravitreal injections of 0.5 mg of ranibizumab or 2 mg of aflibercept can influence the morphology of the corneal endothelium but not CCT.

Copyright © 2020 Beata Urban et al.