オツジ　ツヨシ   OTSUJI TSUYOSHI   尾辻　剛    所属   関西医科大学  眼科学講座    職種   准教授
言語種別	日本語
発表タイトル	Tachyphylaxis to Ranibizumab in the treatment of AMD
会議名	第51回日本網膜硝子体学会総会
発表者・共同発表者	◎Koike N, Otsuji T , Sho K, Tsumura A, Tsuda M, Nishimura T, Takahashi K
発表年月日	2012/11
開催地 （都市, 国名）	山梨
概要	Purpose: Among the patients with exudative age-related macular degeneration (AMD) who receive intravitreal injections of Ranibizumab (IVR), there are some patients who develop tachyphylaxis to Ranibizumab. They respond to Ranibizumab at their initial therapy, but the response decreases after following repeated administration. We assessed those cases of tachyphylaxis retrospectively. Methods: One hundred forty two eyes of 142 patients with AMD were included in this study. They received three IVR treatments every 4 weeks for their initial treatment. After the treatments they received IVR if necessary. They had to have a minimum of 12 months follow-up. Recognizing an increase of best-corrected visual acuity (BCVA) or a decrease in central retinal thickness (CRT), we considered both changes as a response to Ranibizumab. On the condition that BCVA didn’t improve and the CRT didn’t decrease, we defined it a complete lack of response. We defined an increase or decrease of ≧0.3 logMAR lines as significant. Results: We found a 4.2% rate (6/142) of tachyphylaxis in eyes treated with Ranibizumab. The average lesion size was 4584.8 ㎛. In this study, all patients with tachyphylaxis had typical AMD and the lesion type was occult with no classic CNV in 4 eyes and predominantly classic CNV in 2 eyes. We could not find any significant differences in their lesion characteristics between the patients with tachyphylaxis and those without tachyphylaxis. As an additional treatment, 2 eyes received photodynamic therapy (PDT) and 1 eye had an administration of Pegaptanib. Any exudation could not be found in the two eyes having PDT. Conclusion: Except for the fact that all AMD patients with tachyphylaxis to Ranibizumab were diagnosed with typical AMD, no differences were found between the two groups.