ベバシズマブ硝子体注入および線維柱帯切除術が奏効した結核性ぶどう膜炎の1例

A case of tuberculous uveitis with favorable response to intravitreal bevacizumab and trabeculectomy

要約　目的：ベバシズマブの硝子体注入と線維柱帯切除術が奏効した結核性ぶどう膜炎の1例の報告。症例：41歳男性に6か月前から発咳と倦怠感があり，2週間前からの血管新生緑内障と網膜静脈炎を契機として肺結核が発見された。所見：矯正視力は右1.5，左0.6で，眼圧は右16mmHg，左48mmHgであった。両眼に網膜静脈の白鞘化，左眼に硝子体出血と虹彩ルベオーシスがあった。左眼にベバシズマブの硝子体注入，両眼に光凝固を行い，左眼にマイトマイシン併用の線維柱帯切除術を行った。6か月後の現在，左眼は1.2の視力と16mmHgの眼圧を維持している。結論：血管新生緑内障を併発した結核性ぶどう膜炎に対し，ベバシズマブの硝子体注入と網膜光凝固が奏効した。

Abstract.　Purpose：To report a case of tuberculous uveitis with neovascular glaucoma that responded to retinal photocoagulation,intravitreal bevacizumab and trabeculectomy. Case：A 41-year-old male was referred to us for neovascular glaucoma and retinal vasculitis. He had been diagnosed with pulmonary tuberculosis 2 weeks before. Findings：Corrected visual acuity was 1.5 right and 0.6 left. Intraocular pressure（IOP）was 16 mmHg right and 48 mmHg left. Both eyes showed retinal periphlebitis. The left eye showed vitreous hemorrhage and rubeosis iridis. The left eye was treated by intravitreal injection of bevacizumab. Both eyes received retinal photocoagulation. The left eye was also treated by trabeculectomy with adjunct use of mitomycin C. The patient is doing well 6 months after his initial visit with visual acuity of 1.2 and IOP of 16 mmHg in the left eye. Conclusion：Tuberculous uveitis with neovascular glaucoma in the present case responded to retinal photocoagulation,intravitreal bevacizumab and trabeculectomy.