{"created":"2021-03-01T06:09:33.953724+00:00","id":5698,"links":{},"metadata":{"_buckets":{"deposit":"443dda67-48f5-46b0-bd65-5b3cca9b722d"},"_deposit":{"id":"5698","owners":[],"pid":{"revision_id":0,"type":"depid","value":"5698"},"status":"published"},"_oai":{"id":"oai:niigata-u.repo.nii.ac.jp:00005698","sets":["453:455","471:561:562"]},"item_6_alternative_title_1":{"attribute_name":"その他のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"One-Year Outcomes of Switching Therapy from Ranibizumab to Aflibercept for Exdative Age-Related Macular Degeneration"}]},"item_6_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2016-03-23","bibliographicIssueDateType":"Issued"},"bibliographicPageEnd":"12","bibliographicPageStart":"1","bibliographic_titles":[{}]}]},"item_6_date_granted_51":{"attribute_name":"学位授与年月日","attribute_value_mlt":[{"subitem_dategranted":"2016-03-23"}]},"item_6_degree_grantor_49":{"attribute_name":"学位授与機関","attribute_value_mlt":[{"subitem_degreegrantor":[{"subitem_degreegrantor_name":"新潟大学"}]}]},"item_6_degree_name_48":{"attribute_name":"学位名","attribute_value_mlt":[{"subitem_degreename":"博士（医学）"}]},"item_6_description_4":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"【目的】難治性滲出型加齢黄斑変性(age-related macular degeneration:AMD)に対して、ラニビズマブからアフリベルセプトへ切り替え治療を行った1年成績を検討した。【対象と方法】対象症例は過去にラニビズマブ治療歴のある難治性のAMDに対してアフリベルセプト硝子体内注射(intravitreous injection of aflibercept : IVA)に切り替えて治療を開始し1年間経過観察が可能であった滲出型AMD31例32眼（男性23例24眼、女性8例8眼）、年齢は58～92歳（平均75.0±8.3歳）であった。病型は、典型AMD(typical AMD : t-AMD)16眼、ポリープ状脈絡膜血管症(polypoidal choroidal vasculopathy : PCV)14眼、網膜血管腫様増殖(retinal angiomatous proliferation : RAP)1眼であった。IVRへの切り替え理由は、再発例19眼、反応不良例9眼、効果減弱例4眼であった。検討項目は、IVA切り替え直前と切り替え後1年の視力、光干渉断層計(optical coherence tomography : OCT)により計測された中心窩黄斑厚(central macular thickness : CMT)、1年の時点で滲出性変化の消失した割合(%)を計算した。視力変化はlogMAR視力で0.3以上の変化を有意とした。投与法別に滲出性変化の消失した割合を比較した。【結果】平均視力は切り替え前0.50±0.36、切り替え後0.47±0.46であり、有意な改善は認められなかった。視力改善6眼(18.8%)、不変21眼(65.6%)、悪化5眼(15.6%)であった。平均CMTは495.9±247.3μmから305.7±178.9μmで有意に改善していた。滲出性変化の消失した割合は65.6%であった。固定投与では71.4%、必要時投与では61.1%で滲出性変化が消失した。投与法別では滲出性変化の消失した割合に有意な差はなかった。切り替え理由別では、再発例19眼中15眼(78.9%)、反応不良例9眼中4眼(44.4%)、耐性例4眼中2眼(50%)で滲出性変化が消失した。病型別では、PCV14眼中9眼(64.3%)、AMD16眼中10眼(62.5%)、RAP2眼中2眼(100%)で滲出性変化が消失した。網膜色素上皮剥離(retinal pigment epithelium detachment : PED)を有した症例19眼中では、消失12眼(63.2%)、減少5眼(26.3%)、不変2眼(10.5%)であった。一年間の投与回数は1～7（平均4.7±1.7）回であった。【結論】ラニビズマブ難治例に対するアフリベルセプトへの切り替えは、滲出性変化の改善と視力維持に有効であった。切り替えにても滲出性変化が消失しない難治な症例が存在し、投与回数の増加と共にアフリベルセプトの耐性例が増加することが予想され、更なる多様な治療戦略が必要である。","subitem_description_type":"Abstract"}]},"item_6_description_5":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"学位の種類: 博士（医学）. 報告番号: 甲第4113号. 学位記番号: 新大院博（医）甲第680号. 学位授与年月日: 平成28年3月23日","subitem_description_type":"Other"}]},"item_6_description_53":{"attribute_name":"学位記番号","attribute_value_mlt":[{"subitem_description":"新大院博（医）甲第680号","subitem_description_type":"Other"}]},"item_6_dissertation_number_52":{"attribute_name":"学位授与番号","attribute_value_mlt":[{"subitem_dissertationnumber":"13101甲第4113号"}]},"item_6_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"50748","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Sato, Yayoi"}]}]},"item_6_publisher_7":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"新潟大学"}]},"item_6_select_19":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_select_item":"ETD"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"佐藤, 弥生"}],"nameIdentifiers":[{"nameIdentifier":"50747","nameIdentifierScheme":"WEKO"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2019-08-05"}],"displaytype":"detail","filename":"h27nmk680.pdf","filesize":[{"value":"973.2 kB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"本文","url":"https://niigata-u.repo.nii.ac.jp/record/5698/files/h27nmk680.pdf"},"version_id":"4d87fe16-7650-4f70-a3d2-a830f43a4422"},{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2019-08-05"}],"displaytype":"detail","filename":"h27nmk680_a.pdf","filesize":[{"value":"576.6 kB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"要旨","url":"https://niigata-u.repo.nii.ac.jp/record/5698/files/h27nmk680_a.pdf"},"version_id":"acd37538-8915-4a77-92be-9f8e7f4ca8e2"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"加齢黄斑変性","subitem_subject_scheme":"Other"},{"subitem_subject":"ラニビズマブ","subitem_subject_scheme":"Other"},{"subitem_subject":"アフリベルセプト","subitem_subject_scheme":"Other"},{"subitem_subject":"切り替え治療","subitem_subject_scheme":"Other"},{"subitem_subject":"1年成績","subitem_subject_scheme":"Other"},{"subitem_subject":"age-related macular degeneration : AMD","subitem_subject_scheme":"Other"},{"subitem_subject":"ranibiazumab","subitem_subject_scheme":"Other"},{"subitem_subject":"aflibercept","subitem_subject_scheme":"Other"},{"subitem_subject":"switching therapy","subitem_subject_scheme":"Other"},{"subitem_subject":"one-year outcomes","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"thesis","resourceuri":"http://purl.org/coar/resource_type/c_46ec"}]},"item_title":"滲出型加齢黄斑変性に対するラニビズマブからアフリベルセプト切り替え治療の１年成績","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"滲出型加齢黄斑変性に対するラニビズマブからアフリベルセプト切り替え治療の１年成績"},{"subitem_title":"滲出型加齢黄斑変性に対するラニビズマブからアフリベルセプト切り替え治療の１年成績","subitem_title_language":"en"}]},"item_type_id":"6","owner":"1","path":["455","562"],"pubdate":{"attribute_name":"公開日","attribute_value":"2016-05-19"},"publish_date":"2016-05-19","publish_status":"0","recid":"5698","relation_version_is_last":true,"title":["滲出型加齢黄斑変性に対するラニビズマブからアフリベルセプト切り替え治療の１年成績"],"weko_creator_id":"1","weko_shared_id":2},"updated":"2022-12-15T03:38:52.120672+00:00"}