遠視化をきたしたビスホスホネート製剤によるぶどう膜炎と眼窩内炎症の1例

A case of uveitis and orbital inflammation with hyperopic shift following systemic treatment with bisphosphonate

要約　緒言：ビスホスホネート（BP）製剤投与後に片眼性の遠視化と強膜炎，虹彩炎，眼窩内炎症を生じた症例の報告。

症例：77歳男性で，腎細胞癌による骨転移の既往がある。他院でゾレドロン酸注射後に左眼痛と充血を自覚し，近医を受診した。抗菌薬とステロイド薬点眼で症状は改善したが，BP製剤の再投与後に同様の所見が再発した。

所見と経過：両眼の矯正視力は1.0で，屈折値は右眼の＋1.0Dと比べ左眼は＋5.0Dと遠視が強く，左眼圧は25mmHgであった。左眼は毛様充血，中等度の虹彩炎，眼球突出があり，上転障害と内転障害を伴っていた。光干渉断層計で左眼は右眼に比べて脈絡膜が肥厚していた。眼窩MRIで両眼の外直筋と下直筋の腫大，左眼後部強膜の肥厚を認めたが，脳血管造影で内頸動脈海綿静脈洞瘻はなかった。ステロイド薬点眼で経過観察したところ，虹彩炎や眼球運動障害などの眼症状は改善し，左眼の屈折値は＋2.5Dへと減少し，脈絡膜厚は正常化した。

結論：BP製剤投与後にぶどう膜炎と眼窩内炎症が発症し，時として遠視化を伴うことがある。

Abstract　Purpose：To report a case who developed uveitis and orbital inflammation with hyperopic shift following systemic treatment with bisphosphonate.

Case：A 77-year-old man was referred to us for pain and blurring of vision in the left eye. He had renal cell carcinoma with bone metastasis. The left eye developed hyperemia after the first and second session of intravenous infusion of zoledronate.

Findings and Clinical Course：Corrected visual acuity was 1.0 in either eye. The left eye showed hyperopia of ＋5 diopters. Intraocular pressure was 19 mmHg right and 25 mmHg left. The left eye showed restricted motility, proptosis, eyelid swelling, and signs of iritis. Optical coherence tomography showed thickening of the choroid in the left eye. Magnetic resonance imaging（MRI）showed thickened posterior wall of the eyeglobe. Discontinuation of zoledronate and topical corticosteroid was followed by improved ocular motility, reduced eyelid swelling, and decreased choroidal thickening. The left eye showed refraction of ＋2.5 diopters three weeks after his initial visit. There has been no recurrence for 17 months until present.

Conclusion：The present case illustrates that systemic treatment with bisphosphonate may induce uveitis and orbital inflammation with hyperopic shift.