パゾパニブ内服中に裂孔原性網膜剝離を発症した1例

A case of rhegmatogenous retinal detachment associated with pazopanib

要約　目的：マルチチロシンキナーゼ阻害薬であるパゾパニブ（PZP）には裂孔原性網膜剝離（RRD）の合併症が報告されている。本報告はPZP内服開始後に発症したRRDの本邦における最初の報告である。

症例：46歳，男性。左鼠径部の悪性軟部腫瘍に対して化学療法が開始されたが効果不良で，2か月後に腫瘍切除術が施行された。その後，術後補助化学療法としてPZPの内服が開始された。PZP開始1か月後に飛蚊症を自覚し，2か月後に近医眼科を受診したところ，右眼に裂孔が観察された。RRDと診断され，当科に紹介となった。アトピーや外傷などの既往歴なし。初診時の矯正視力は右1.0，左1.2，右眼の耳上側から黄斑剝離を伴わない胞状剝離を認めた。術前日よりPZPを中止し，水晶体温存硝子体手術を施行した。術後網膜は良好に復位したが，光凝固瘢痕の形成遷延を認めた。また，術6か月後に左眼網膜周辺部変性に予防的に網膜光凝固を施行し，瘢痕形成は良好であった。

結論：PZP内服中の患者ではRRDや網膜裂孔などの眼合併症の可能性を考慮することが重要である。

Abstract　Purpose：Pazopanib（PZP）, a multi-tyrosine kinase inhibitor, is associated with complications of rhegmatogenous retinal detachment（RRD）. This report describes the first case of RRD that developed after the initiation of oral PZP therapy in Japan.

Case：A 46-year-old man underwent chemotherapy for a malignant soft tissue tumor in the left inguinal region. However, the response was poor, and tumor resection was performed 2 months later. Oral PZP was initiated as postoperative adjuvant chemotherapy. The patient noticed floaters 1 month later, and he visited a local ophthalmology clinic 2 months later. He was diagnosed with RRD in the right eye and was referred to our department. He had no history of atopy, ocular trauma, or other relevant conditions. At the initial visit, best-corrected visual acuity was 1.0 for the right eye and 1.2 for the left eye. A bullous retinal detachment without macular involvement was observed in the superotemporal quadrant of the right eye. PZP was discontinued 1 day before surgery, and lens-sparing pars plana vitrectomy was performed. The retina was successfully reattached postoperatively, but delayed formation of laser photocoagulation scars was observed. Prophylactic retinal photocoagulation was performed for peripheral retinal degeneration in the left eye at 6 months after surgery, and scar formation was satisfactory.

Conclusion：Retinal detachment, including RRD, has been reported in patients receiving PZP. The potential risk of ocular complications, including RRD and retinal degeneration, should be considered in patients receiving PZP treatment.