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要約 目的:ファリシマブ硝子体内注射(IVF)後に網膜動静脈閉塞を伴う非感染性眼内炎症(IOI)を発症した1例を経験したので報告する。
症例:77歳,男性。左眼の未治療の滲出型加齢黄斑変性type 1黄斑部新生血管に対して,自治医科大学附属病院(当院)でアフリベルセプト硝子体内注射13回,半量光線力学療法1回を施行したところ安定したため前医へ逆紹介となった。その後,再燃し同院にてアフリベルセプト硝子体内注射を複数回施行したが頻回再燃のため当院へ再紹介となり,ブロルシズマブ硝子体内注射5回を施行したが頻回再燃のためIVFへ切り替えた。
所見:IVF 4回目から11日後(初回IVFから319日後)に視野狭窄を自覚し,14日後に当院を受診した。左矯正視力は最終投与前0.5から0.4へ低下しており,前眼部および中間透光体に異常所見はなかった。左眼底の視神経乳頭より上耳側を走行する網膜動脈の白鞘化と網膜虚血性変化を認め,蛍光眼底造影検査にて同部位の網膜動静脈分枝の閉塞を認めた。IVFによる網膜血管閉塞を伴うIOIを疑い,トリアムシノロンアセトニド20mgのテノン囊下注射を施行した。1か月後,自覚症状は改善し,網膜動脈白鞘化も一部改善を認めた。下方視野の自覚症状は改善を認め,矯正視力は0.7まで改善した。網膜動静脈閉塞は改善したが,白鞘化した網膜動脈は残存した。
結論:IVFに関連した網膜動静脈分枝閉塞を伴うIOIを報告した。
Abstract Purpose:To report a case of intraocular inflammation(IOI) with concurrent retinal arteriovenous occlusion following intravitreal faricimab(IVF) injection.
Case:A 77-year-old man presented with type 1 macular neovascularization secondary to untreated neovascular age-related macular degeneration(nAMD) in the left eye. After receiving 13 intravitreal aflibercept injections and one half-dose of photodynamic therapy at our hospital, his condition stabilized, and he was referred to his previous ophthalmologist. Following disease recurrence, he received multiple aflibercept injections at the referral clinic. Due to recurrences, he was referred back to our hospital, where he received five intravitreal brolucizumab injections. Due to the continued recurrences, the treatment was switched to IVF. Eleven days after the fourth IVF injection(319 days after the initial injection), the patient reported visual field constriction. Fourteen days later, the decimal best-corrected visual acuity(BCVA) in the left eye decreased from 0.5 to 0.4. While the anterior segment and vitreous were unremarkable, fundoscopic examination revealed white sheathing of the superotemporal retinal artery emanating from the optic disc, accompanied by retinal ischemic changes. Fluorescein angiography confirmed a branch retinal arteriovenous occlusion in the corresponding retinal area. A 20-mg sub-Tenon injection of triamcinolone acetonide was administered for suspected IVF-induced IOI with retinal artery occlusion. One month after treatment, the patient's subjective symptoms improved, with partial resolution of the white sheathing of the retinal artery. The inferior visual field defect improved, and BCVA recovered to 0.7. Although the branch retinal venous occlusion resolved, white sheathing of the retinal artery persisted.
Conclusion:IOI with concomitant retinal arteriovenous occlusion associated with IVF has been reported.

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