COVID-19ワクチン接種後にぶどう膜炎を発症した2症例

Two cases of posterior uveitis after COVID-19 vaccination

要約　目的：COVID-19ワクチン2回目接種後に後眼部ぶどう膜炎を発症した2症例を報告する。

症例1：COVID-19ワクチン接種後に視力低下を自覚した40歳女性。視力は右（1.2），左（0.8），両視神経乳頭の発赤・腫脹，漿液性網膜剝離（SRD）があり，光干渉断層計（OCT）でSRDと脈絡膜肥厚を認めた。フルオレセイン蛍光眼底造影（FA）で多数の蛍光漏出と網膜下蛍光貯留，インドシアニングリーン蛍光眼底造影（IA）で脈絡毛細血管への充盈遅延，多発斑状低蛍光，多発点状蛍光漏出があり，髄液細胞増多を認めた。以上より，Vogt-小柳-原田病と診断し，ステロイドパルス療法を施行して所見は改善し，再発なく経過した。

症例2：COVID-19ワクチン5回目接種後に霧視を自覚した72歳女性。視力は右（0.9），左（0.3），左眼に角膜後面沈着物，前房炎症，硝子体混濁と周辺部網膜に滲出斑があり，FAで血管炎を認めた。41年前に急性網膜壊死（ARN）の既往があり，前房水PCRから水痘帯状疱疹ウイルスが検出され，ARNの再発と診断した。アシクロビル，ステロイド，アスピリン併用療法で所見は改善した。

結論：COVID-19ワクチン接種に伴う免疫反応を契機としてぶどう膜炎を発症する可能性がある。

Abstract　Purpose：To report two cases of posterior uveitis developing after COVID-19 vaccination.

Case 1：A 40-year-old woman presented with decreased vision after receiving the second dose of the COVID-19 vaccine. She had a best corrected visual acuity（BCVA）of 1.2 in the right eye（OD）and 0.8 in the left eye（OS）. Hyperemia of optic discs and serous retinal detachment（SRD）were found in the bilateral fundus. Optical coherence tomography showed SRD and choroidal thickening. Fluorescein angiography（FA）showed multiple fluorescent leakage points and subretinal fluorescent accumulation, and indocyanine green angiography showed delayed filling of choroidal capillaries, multiple hypofluorescence spots, and fluorescent leaks. Cerebrospinal fluid examination revealed plecytosis. Therefore, she was diagnosed with Vogt-Koyanagi-Harada disease, and treated with steroid pulse therapy, with improvement in findings and no recurrence.

Case 2：A 72-year-old woman became developed foggy vision after the fifth dose of the COVID-19 vaccine. BVCA was 0.9 OD and 0.3 OS. In the left eye, keratic precipitates, anterior chamber inflammation, vitreous opacity, and exudative plaques in the peripheral retina were present, and FA showed vasculitis. In addition, she had acute retinal necrosis（ARN）41 years ago, and varicella zoster virus was detected on polymerase chain reaction examination of the aqueous humor. Thus, we diagnosed recurrent ARN. The findings improved with acyclovir, steroids, and aspirin combination therapy.

Conclusion：Uveitis may be triggered by an immune response to COVID-19 vaccination.