PDF(Pubmed)
Abstract：
Even in the post-coronavirus disease 2019 (COVID-19) era, it is prudent to exercise caution regarding the timing between intravitreal anti-vascular endothelial growth factor (VEGF) injections and COVID-19 vaccinations, as ocular inflammation can occur following both procedures. However, this perspective has not been sufficiently discussed thus far. Herein, we report a case of acute noninfectious anterior ocular inflammation following an intravitreal injection of ranibizumab biosimilar (RBZ BS, Senju Pharmaceuticals, Japan) in a patient recently vaccinated against COVID-19. A 74-year-old male with myopic choroidal neovascularization (CNV) in the left eye was treated with RBZ BS intravitreal injection. He received his fourth COVID-19 vaccination with messenger ribonucleic acid (mRNA)-1273 (Moderna) two days prior to his second RBZ BS intravitreal injection. He reported no systemic symptoms associated with the fourth COVID-19 vaccination. The second RBZ BS intravitreal injection was safely performed without complications. However, a few hours later, he experienced blurred vision without ocular pain in his left eye, a symptom not observed after the first injection. He visited a local ophthalmologic clinic the following day and was subsequently referred to our hospital due to anterior ocular inflammation in the left eye. His vision in the left eye was 0.3 decimal best-corrected visual acuity. Examination revealed non-granulomatous anterior ocular inflammation with 3+ cells and 2+ flare in the left eye. Anterior vitreous inflammation, keratic precipitates, or conjunctivitis was absent. Fundus examination also showed no signs of posterior inflammation. Both fluorescence angiography and indocyanine green angiography revealed staining corresponding to CNV without retinal vasculature leakage. There is nothing abnormal with the right eye based on the examination. Given that the noninfectious ocular inflammation was likely, based on the acute onset of symptoms within less than 24 hours following the RBZ BS intravitreal injection, and the presence of non-granulomatous inflammation only in the anterior segment without ocular pain, betamethasone eye drops four times daily was initiated in the left eye on the first day following the second RBZ BS intravitreal injection. Then, his ocular inflammation improved to mild by the fourth day post-injection. His eye eventually cleared, with no cells or flare in the anterior chamber at five months. Eventually, given the clinical course of good response to only topical steroid therapy, the diagnosis of noninfectious anterior ocular inflammation following RBZ BS in the case of a recent episode of COVID-19 vaccination was retrospectively confirmed. Although this case represents one of the initial instances of noninfectious ocular inflammation following RBZ BS (Senju Pharmaceuticals) administration, sterile ocular inflammation after other intravitreal anti-VEGF therapy has already been well-reported. In addition, given the recent COVID-19 vaccination, the ocular inflammation might be influenced by the vaccination, synergistically leading to vaccine-associated uveitis with similar signs and symptoms. In conclusion, to prevent such a complex situation, it is advisable to consider an adequate interval between COVID-19 vaccination and intravitreal anti-VEGF injections.
摘要：
即使在2019年后冠状病毒病(COVID-19)时代，在玻璃体内注射抗血管内皮生长因子（VEGF）和COVID-19疫苗接种之间的时间安排方面，谨慎行事，因为这两种程序都可能发生眼部炎症。然而,到目前为止，这种观点还没有得到充分讨论。在这里，我们报告了一例急性非感染性眼前部炎症在玻璃体内注射雷珠单抗生物仿制药（RBZBS，Senju制药，日本）最近接种了COVID-19疫苗的患者。用RBZBS玻璃体内注射治疗左眼患有近视脉络膜新生血管（CNV）的74岁男性。在第二次RBZBS玻璃体内注射前两天，他接受了第四次COVID-19信使核糖核酸（mRNA）-1273（Moderna）疫苗接种。他报告没有与第四次COVID-19疫苗接种相关的全身症状。第二次RBZBS玻璃体内注射安全进行，无并发症。然而,几个小时后,他的左眼没有眼痛，视力模糊，第一次注射后没有观察到的症状。第二天，他去了当地的眼科诊所，随后由于左眼前眼炎而被转诊到我们医院。他的左眼视力为0.3十进制最佳矫正视力。检查显示左眼有3+细胞和2+耀斑的非肉芽肿性眼前部炎症。玻璃体前炎症,角质沉淀物，或无结膜炎。眼底检查也没有显示后部炎症的迹象。荧光血管造影术和吲哚菁绿血管造影术均显示对应于CNV的染色，无视网膜血管渗漏。根据检查，右眼没有异常。鉴于非感染性眼部炎症很可能，基于RBZBS玻璃体内注射后24小时内症状的急性发作，和非肉芽肿性炎症的存在仅在眼前段没有眼部疼痛，在第二次RBZBS玻璃体内注射后的第一天,在左眼开始每日四次的倍他米松滴眼液.然后，注射后第四天，他的眼部炎症改善至轻度。他的眼睛最终消失了，五个月前房没有细胞或耀斑。最终,鉴于仅对局部类固醇治疗反应良好的临床过程，在最近一次COVID-19疫苗接种的病例中,经RBZBS后诊断为非感染性眼前眼炎.尽管此病例代表了RBZBS（SenjuPharmaceuticals）给药后非感染性眼部炎症的最初实例之一，其他玻璃体内抗VEGF治疗后的无菌性眼部炎症已经得到充分报道.此外,鉴于最近的COVID-19疫苗接种，眼部炎症可能受到疫苗接种的影响，协同导致具有相似体征和症状的疫苗相关葡萄膜炎。总之,为了防止这种复杂的情况，建议在COVID-19疫苗接种和玻璃体内注射抗VEGF之间考虑适当的间隔时间.
