タクロリムス点眼使用開始後に角膜ヘルペスを生じた5例

Five cases of herpetic keratitis following topical treatment with tacrolimus ophthalmic solution

要約　目的：タクロリムス点眼の使用中に角膜ヘルペスが生じた5例の記述と，その背景の報告。

対象と方法：2016年までの5年間に，タクロリムス点眼を使用し3か月以上経過観察ができた49例を対象とし，基礎疾患と角膜ヘルペスとの関連と危険因子などを検討した。

結果：49例中5例で角膜ヘルペスが生じた。5例の内訳は，男性4例，女性1例で，年齢は7〜42歳，中央値は40歳であった。角膜ヘルペスは3例で両眼に，2例で片眼に発症した。角膜ヘルペスは，タクロリムスの使用開始から14〜240日後，中央値36日後に生じた。5例中4例に角膜ヘルペスの既往があり，有意に多かった（p＜0.05）。アシクロビルの点眼または内服で，角膜ヘルペスは治癒した。タクロリムス点眼を使用した49例は，男性32例，女性17例で，23例にアトピー性皮膚炎，37例に春季カタルなどアレルギー性角膜疾患，6例に角膜ヘルペスの既往があった。

結論：アトピー性皮膚炎または角膜ヘルペスの既往がある症例では，タクロリムスの点眼で，角膜ヘルペスが発症または再発しやすい。

Abstract　Purpose：To report 5 cases who developed herpetic keratitis following topical treatment with tacrolimus ophthalmic solution and to describe background features associated with this complication.

Cases and Method：Herpetic keratitis developed in 5 cases following topical treatment with tacrolimus ophthalmic solution from January 2011 to March 2016. A total of 49 cases, who were treated by topical tacrolimus during the same period, were retrospectively evaluated regarding the underlying diseases and risk factors for herpetic keratitis.

Results：The series comprised 4 males and one female. The age ranged from 7 to 42 years, with median of 40 years. Herpetic keratitis was bilateral in 3 cases and unilateral in 2 eyes. It developed 14 to 240 days, median 36 days, after initiation of tacrolimus ophthalmic solution. Four cases had past history of herpetic keratitis. This incidence was significant when compared with 49 cases in this study. The 49 cases comprised 32 males and 17 females. There were 23 cases of atopic dermatitis, 37 cases of allergic conjunctivitis including vernal catarrh, and 6 cases of herpetic keratitis in the past.

Conclusion：There is a high risk of occurrence or recurrence of herpetic keratitis following topical treatment with tacrolimus in cases with atopic dermatitis or past history of herpetic keratitis.