糖尿病黄斑浮腫に対するfaricimab硝子体内注射後に発症した両眼の黄斑虚血を伴う眼内炎症の1例

A case of bilateral intraocular inflammation with macular ischemia after intravitreal injection of faricimab for diabetic macular edema

要約　目的：糖尿病黄斑浮腫に対するfaricimab硝子体内注射後に黄斑虚血を伴う眼内炎症が両眼に生じた1例を経験したので報告する。

症例：60歳，女性。糖尿病網膜症の精査目的で日本大学病院を受診した。初診時視力は右（0.6），左（0.8），両眼に囊胞様黄斑浮腫を認めた。フルオレセイン蛍光眼底造影では両眼に広範囲の無灌流領域を認めたため汎網膜光凝固術を施行した。2か月後，両眼黄斑浮腫に対して，右眼にfaricimab硝子体内注射（IVF）を行い，7日後左眼にもIVFを行った。左眼注射後翌日に両眼霧視が出現し，視力は右（0.08），左（0.1）となり，両眼前房内セルフレア値の上昇，黄斑周囲に白濁病変の出現，ゴールドマン視野計では両眼に中心暗点を認めた。黄斑部網膜血管造影の充盈欠損を認めたため，IVF後眼内炎症による黄斑虚血と考え，副腎皮質ステロイドの眼局所投与で加療を開始した。7か月後，炎症所見は改善したが中心暗点は残存した。

結論：糖尿病黄斑浮腫に対するfaricimab硝子体内注射後，両眼に黄斑虚血を伴う眼内炎症の1例を経験した。Faricimabは他の抗血管内皮増殖因子薬と同様に網膜血管閉塞を伴う眼内炎症が生じる可能性がある。

Abstract　Purpose：We report a case of intraocular inflammation with macular ischemia in both eyes after intravitreal injection of faricimab for diabetic macular edema.

Case：A 60-year-old woman presented for the evaluation of diabetic retinopathy. Visual acuity was 0.6 in the right eye and 0.8 in the left eye at the time of initial examination. Optical coherence tomography revealed macular edema, and fluorescein fluorescence fundus angiography showed extensive areas of nonperfusion in both eyes. Two months after pan-retinal photocoagulation, the patient underwent intravitreal injection of faricimab in the right eye for macular edema, and 7 days later, the injection was also administered in the left eye. The day after the injection in the left eye, the patient developed foggy vision in both eyes. Visual acuity was 0.08 in the right eye and 0.1 in the left eye. Elevated flare values in the anterior chamber of both eyes, perimacular white lesions in the fundus, and central dark spots on visual field testing were observed. Macular retinal angiography showed a filling and waxing defect, which was thought to be macular ischemia due to intraocular inflammation after vitreous injection of faricimab. Treatment was initiated with topical ocular administration of corticosteroids. Seven months later, the inflammatory findings had improved, but the central dark spot remained.

Conclusion：We experienced a case of intraocular inflammation with macular ischemia in both eyes after vitreous injection of faricimab for diabetic macular edema. Faricimab, like other anti-VEGF agents, may cause intraocular inflammation with retinal vascular occlusion.