アフリベルセプト硝子体内注射後に生じた再発性眼内炎の1例

A case of recurrent endophthalmitis after intravitreal injections of aflibercept

要約　目的：アフリベルセプト硝子体内注射後に再発性の眼内炎を生じ，原因として免疫反応が疑われる症例を経験したので報告する。

症例：74歳，女性。左加齢黄斑変性に対してアフリベルセプト硝子体内注射を15回受けた後，ラニビズマブ硝子体内注射を6回受けた。網膜下出血をきたしたため，再びアフリベルセプトに変更したところ，2回目の注射直後から左眼痛を生じ，霧視が増悪した。左眼に前房内細胞，微細な角膜後面沈着物と硝子体混濁を認めた。感染性眼内炎を疑い硝子体手術を施行し，抗菌薬の点眼と静脈内投与を行った。翌日より眼痛と炎症所見は改善した。硝子体の培養結果は陰性であった。炎症が完全に消退した後，左眼アフリベルセプト硝子体内注射を行ったところ再び眼痛を生じ，前回と明らかに同様の炎症所見を認めた。アフリベルセプトに対する免疫反応を疑い，ステロイドと抗菌薬の点眼加療を行った。炎症は軽快し，その後のラニビズマブの注射では，炎症の再発は認めなかった。

結論：アフリベルセプトに対する免疫反応が原因と考えられる再発性の眼内炎の症例を経験した。

Abstract　Purpose：To report a case of recurrent endophthalmitis after intravitreous injections of aflibercept, which was suspected to be caused by an autoimmune response.

Case：A 74-year-old woman with age-related macular degeneration in the left eye had received fifteen intravitreous injections of aflibercept, followed by six injections of ranibizumab. Thereafter, the patient developed subretinal hemorrhage, following which the regimen was switched back to aflibercept therapy. Immediately after the second injection, the patient developed ocular pain with worsening blurred vision. The injected eye showed cells in the anterior chamber, fine keratic precipitates, and vitreous opacity. We suspected an infectious endophthalmitis and performed a vitrectomy with topical and intravenous antibiotics. The pain and inflammation resolved on the next day. Culture test of the vitreous sample gave a negative result. After complete regression of the endophthalmitis, the patient received aflibercept injection, which again caused inflammation, with apparently the same findings as those during the previous event. We then suspected an autoimmune response to aflibercept and treated the eye with topical steroid and antibiotics. The inflammation revolved immediately and never recurred during subsequent injections of ranibizumab.

Conclusion：We encountered a patient with recurrent endophthalmitis after aflibercept injections possibly due to an autoimmune response to the drug.