COVID-19ワクチン接種後に急性びまん性点状表層角膜炎を呈した1例

Acute diffuse superficial punctate keratitis after COVID-19 vaccination: a case report

要約　目的：COVID-19に対するワクチン接種後にぶどう膜炎，角膜移植後拒絶反応，網膜静脈閉塞症などさまざまな眼副反応を生じることが報告されている。今回，COVID-19 mRNAワクチン〔コミナティ（以下，コロナワクチン）〕接種後に急性発症したと考えられるびまん性点状表層角膜炎の1例を経験したので報告する。

症例：24歳，女性｡2週間使い捨てソフトコンタクトレンズ常用者で，コロナワクチン1回目接種7時間後より両眼の視力低下・眼痛を自覚，翌々日の近医受診時に視力は右（0.7p），左（0.4p）と低下を認め，びまん性点状表層角膜症としてヒアルロン酸ナトリウム0.1％，ジクアホソルナトリウム点眼を開始するも改善せず，発症6日目に当院を紹介され受診となった。当院初診時の視力は右（1.0p），左（0.4），両眼にびまん性点状表層角膜炎と角膜浮腫を認め，前眼部OCTにて中心角膜厚は右549μm，左584μmと肥厚しており，また角膜形状異常による不整乱視を認めた。非感染性の角膜炎と診断し，フルオロメトロン0.1％点眼に変更した。治療開始から1か月後には点状表層角膜炎は消失し，視力は両眼ともに（1.2）まで改善，中心角膜厚の肥厚，角膜形状異常も改善した。

結論：ワクチン接種との時間的因果関係から，コロナワクチン接種を契機に急性角膜炎を発症したと考えられた。ステロイド点眼にて改善し，コロナワクチン投与による眼局所での免疫応答が発症に関与している可能性が考えられた。

Abstract　Purpose：Various ocular adverse reactions have been reported following COVID-19 vaccination, including uveitis, corneal transplant rejection, and retinal vein occlusion. In this case, we report diffuse superficial punctate keratitis, which is thought to have developed acutely after vaccination with the COVID-19m-RNA vaccine〔COMIRNATY（Pfizer）, hereinafter called COVID-19 vaccination〕.

Case：A 24-year-old woman who regularly wears disposable soft contact lenses for a 2-week noticed decreased visual acuity and eye pain in both eyes 7 hours after the first vaccination with COVID-19. Two days later, when she visited a local doctor, her corrected visual acuity decreased to 0.7p on the right and 0.4p on the left. Diffuse superficial punctate keratopathy was diagnosed. A sodium hyaluronate 0.1％ and diquafosol sodium eye drops regimen was administered, but there was no improvement. The patient was referred to our hospital on the 6th day after the onset of diffuse superficial keratopathy. Corrected visual acuity at the first visit to our hospital was right（1.0p）, left（0.4）, and diffuse punctate superficial keratitis-like findings and corneal edema were observed in both eyes. Optical coherence tomography（OCT）of the anterior segment revealed thickening of the central corneal, with a thickness of 549μm on the right and 584μm on the left, and an irregular astigmatism owing to abnormal corneal shape. Finally she was diagnosed with non-infectious keratitis and changed to her fluorometholone 0.1％ eye drops. One month after the start of treatment, the superficial punctate keratitis disappeared, the corrected visual acuity improved to（1.2）in both eyes, Additionally, the central corneal thickness and abnormal corneal shape improved.

Conclusions：From the temporal relationship with vaccination, it was thought that the acute keratitis developed after COVID-19 vaccination. Improvement was achieved with steroid eye drops, we suspect the immune response locally in the eye was owing to corona vaccine administration may be involved.