ラニビズマブ投与により網膜色素上皮障害が進行し視力低下をきたした1例

A case of degeneration of retinal pigment epithelium with visual impairment following intravitreal injections of ranibizumab

要約　背景：加齢黄斑変性に対するラニビズマブ硝子体注射は，視力が良好な例にも有効とされている。目的：ラニビズマブ硝子体注射で視力が低下した症例の報告。症例：86歳女性が左眼視力低下で受診した。以前より右眼に加齢黄斑変性（AMD）があった。所見：矯正視力は右0.04，左0.9で，右眼黄斑部にはAMDによる瘢痕，左眼には1乳頭径大の網膜色素上皮剝離があった。左眼にラニビズマブ硝子体注射を行い，その1か月後に網膜色素上皮裂孔が生じた。網膜色素上皮と網膜下出血のあと，初診から14か月後に黄斑に瘢痕形成があり，視力は0.09となった。結論：加齢黄斑変性に対するラニビズマブ硝子体注射で，網膜色素上皮障害が生じることがある。視力が良好な症例では適応に注意を要する。

Abstract.　Background：Intravitreal injection of anti-VEGF,including ranibizumab,is reportedly effective for choroidal neovascularization in age-related macular degeneration（AMD）with good vision. Purpose：To report a case with impaired vision following intravitreal ranibizumab. Case：An 86-year-old female presented with impaired vision in her left eye. She had been diagnosed with AMD in the right eye before. Findings：Corrected visual acuity was 0.04 right and 0.9 left. The right eye showed scar formation in the macula secondary to AMD. The left macula showed serous detachment of retinal pigment epithelium（RPE）on disc diameter across. The left eye received intravitreal injection of ranibizumab. RPE tear was detected one month later followed by massive subretinal hemorrhage. Fibrovascular scarring formed 14 months later with visual acuity of 0.09. Conclusion：This case illustrates that intravitreal ranibisumab may induce RPE lesion. Due precaution is needed in the choice of therapeutic modality in eyes with AMD.