COVID-19ワクチン接種後にMEWDS様の眼底所見を呈した2例

Two cases of MEWDS-like ocular findings following COVID-19 vaccination

要約　緒言：COVID-19ワクチンの副作用と考えられた多発消失性白点症候群（MEWDS）を2例経験したので報告する。

症例1：65歳，女性。3回目のCOVID-19ワクチン接種後2日目に右眼の飛蚊症を主訴に来院した。右矯正視力は0.15と低下しており，前房と硝子体内に炎症所見を認めた。右視神経乳頭から赤道部にかけて白点病変が散在し，眼底自発蛍光（FAF）では白点病変に一致して過蛍光がみられ，光干渉断層計（OCT）ではellipsoid zone（EZ）の途絶が認められた。フルオレセイン蛍光眼底造影（FA）では早期より白点病変に一致して過蛍光を，インドシアニングリーン蛍光眼底造影（IA）の後期では低蛍光を示した。ワクチン接種から6か月で眼底病変は消失した。

症例2：33歳，女性。2回目のCOVID-19ワクチン接種後2か月目に左眼の充血を主訴に来院した。両眼の矯正視力は1.2で，右角膜後面沈着物を認めた。両眼底に白点病変を認め，FAFでは広範囲に過蛍光斑がみられた。OCTではEZの途絶を認めた。FAでは早期から斑状の過蛍光を，IAでは低蛍光を示した。ワクチン接種から4か月で白点病変は消失し，一部は萎縮を残した。

結論：COVID-19ワクチン接種によってMEWDSが誘発された可能性が考えられた。ぶどう膜炎の診察の際には，問診でCOVID-19ワクチン接種の既往を確認する必要があると思われた。

Abstract　Purpose：Here we report two cases of multiple evanescent white dot syndrome（MEWDS）that developed after a coronavirus disease 2019（COVID-19）vaccination.

Case 1：A 65-year-old woman visited our department complaining of floaters in her right eye 2 days after receiving her third COVID-19 vaccination. The best-corrected visual acuity was 0.15 in the right eye'which demonstrated inflammation in the anterior chamber and vitreous. White spotty lesions were scattered from the right optic disc to the equator. Fundus autofluorescence（FAF）showed hyperfluorescence corresponding to the white spotty lesions, and optical coherence tomography（OCT）showed disruption of the ellipsoid zone（EZ）. The white spotty lesions were hyperfluorescent on fluorescein angiography（FA）and hypofluorescence on indocyanine green angiography（IA）. The fundal lesions disappeared 6 months after the vaccination.

Case 2：A 33-year-old woman visited us 2 months after receiving her second COVID-19 vaccination with the chief complaint of redness in her left eye. The best-corrected visual acuity was 1.2 in both eyes, and keratic precipitates were visible in her right eye. Disruption of the EZ was seen on OCT. White dotty lesions were observed widely throughout the bilateral ocular fundi. FAF showed hyperfluorescence corresponding to the spotty lesions. The lesions demonstrated hyperfluorescence and hypofluorescence on FA and IA, respectively. The white spotty lesions disappeared 4 months after the vaccination, leaving some atrophic lesions.

Conclusion：Our cases indicate that MEWDS could be induced by COVID-19 vaccinations. When examining patients with uveitis in clinical practice, clinicians must confirm the history of COVID-19 vaccination.