ベバシズマブ硝子体内注入後に網膜循環不全を発症した1例

A case of retinal vascular dysfunction following intravitreal bevacizumab injection

要約　目的：ベバシズマブの硝子体内注入後に網膜循環不全と視力低下が生じた症例の報告。症例：75歳男性が右眼の視力低下で受診した。2年前から糖尿病で加療中であった。所見と経過：矯正視力は右0.4，左0.5であり，白内障と前増殖網膜症が両眼にあった。右眼に白内障手術と眼内レンズ挿入を行い，視力は1.0に改善した。汎網膜光凝固を行った。手術から3か月後に虹彩ルベオーシスと高眼圧が生じ，硝子体切除術を行った。さらに3か月後にベバシズマブを硝子体内に注入した。その3週間後に視力低下を自覚した。視力は0.01で，網膜動脈の狭細化と白鞘化があり，蛍光眼底造影で著しい循環遅延があった。視神経萎縮が生じ，視力は0.02になった。結論：ベバシズマブの硝子体内注入で網膜に急性循環不全が生じる可能性がある。

Abstract.　Purpose：To report a case who developed retinal vascular dysfunction with acute visual loss following intravitreal injection of bevacizumab. Case：A 75-year-old male presented with impaired visual acuity in the right eye. He had been treated for diabetes mellitus since 2 years before. Findings and Clinical Course：Corrected visual acuity was 0.4 right and 0.5 left. Both eyes showed cataract and preproliferative diabetic retinopathy. Visual acuity in the right eye improved to 1.0 after cataract surgery with intraocular lens implantation. The right eye received panretinal photocoagulation. Vitrectomy was performed 3 months after cataract surgery due to rubeosis iridis and glaucoma. Bevacizumab was injected in the vitreous another 3 months later. Acute visual loss developed 3 weeks later. Visual acuity was 0.01. Retinal vessels showed narrowing and sheathing. Fluorescein angiography showed gross retardation of retinal circulation. Optic atrophy developed with visual acuity down to 0.02. Conclusion：This case illustrates that acute retinal vascular dysfunction may develop after a single intravitreal injection of bevacizumab.