Department of Ocular Tumor, Orbital Disease and Ophthalmic Radiation Therapy., The New York Eye Cancer Center, New York, NY, USA.
Middle East Afr J Ophthalmol. 2020 Oct 30;27(3):182-184. doi: 10.4103/meajo.MEAJO_123_20. eCollection 2020 Jul-Sep.
The literature contains few reports describing autoimmune reactions to intravitreal bevacizumab and no Type-IV delayed hypersensitivity reactions. This was unexpected, as administration of intravenous bevacizumab has frequently caused dermatologic side-effects. This difference was likely attributable in part to the minimum 300-times difference between intravitreal versus intravenous dosing. Here, we present a case of a 52-year-old male who was treated with plaque brachytherapy for a subfoveal choroidal melanoma. The patient was treated with intravitreal bevacizumab for macular edema, retinal detachment and to delay radiation retinopathy. Following his eighth injection, the patient experienced pruritus, rashes, and progressive exacerbations associated with subsequent injections. Cessation of bevacizumab with or without medication (e.g., oral steroid, antihistamine) resulted in complete remission. Switching to periodic intravitreal aflibercept resulted in no additional cutaneous reactions. Physicians administering intravitreal bevacizumab should be aware of this potential systemic side-effect. Its delayed time course facilitates identification and, thus, treatment to resolution.
文献中鲜有描述玻璃体腔内贝伐单抗引起的自身免疫反应，也没有Ⅳ型迟发性超敏反应的报道。这出乎意料，因为静脉内给予贝伐单抗经常引起皮肤副作用。这种差异可能部分归因于玻璃体腔内与静脉内给药的最低 300 倍差异。在此，我们报告了 1 例 52 岁男性患者，因脉络膜黑色素瘤行黄斑下脉络膜瘤斑块近距离放射治疗。该患者因黄斑水肿、视网膜脱离和延迟放射性视网膜病变接受玻璃体腔内贝伐单抗治疗。在第八次注射后，患者出现瘙痒、皮疹，并伴有随后注射的进行性加重。停止使用贝伐单抗（有或无药物治疗，如口服皮质类固醇、抗组胺药）可导致完全缓解。改用周期性玻璃体腔内阿柏西普则没有出现额外的皮肤反应。给予玻璃体腔内贝伐单抗的医生应注意这种潜在的全身副作用。其延迟的时间过程有助于识别和治疗，从而解决问题。
