Bilateral EK Rejection After COVID-19 Vaccine

Evaluation of the early effects of the first-dose administration of the Sinovac vaccine on the retina, choroid, and optic disc using optical coherence tomography (OCT) and OCT-angiography

AIM

To determine the effects of the first-dose administration of the Sinovac vaccine on the retina, choroid, and optic disc in healthy participants.

METHODS

This prospective design study was conducted with 27 healthy healthcare workers who received the first dose of Sinovac vaccine and 25 healthy controls who were not vaccinated. In the vaccinated group, ophthalmological examinations and measurements were performed before vaccination and one week and one month after vaccination. Subfoveal, nasal, and temporal choroidal thicknesses (CTs), retinal nerve fiber layer (RNFL) thickness, and macular thickness (MT) were determined using spectral domain-optical coherence tomography at all visits. Superficial, deep, and peripapillary radial capillary plexus (superficial capillary plexus, deep capillary plexus (DCP), and radial peripapillary capillary, respectively), choriocapillaris vascular density, and foveal avascular zone parameters were measured on optical coherence tomography-angiography (OCT-A).

RESULTS

No significant difference was detected between the two groups in terms of the parameters measured by OCT and OCT-A (p > 0.05 for all). The CT values measured in all quadrants were significantly higher at the first week after vaccination (p < 0.05 for all), and they returned to their pre-vaccination values at the first month post-vaccination measurement (p > 0.05 for all). Concerning the RNFL and MT values, there was no significant difference between the pre-vaccination and post-vaccination first-week measurements (p > 0.05 for all), but a statistically significant increase was detected in the post-vaccination first-month MT and RNFL measurements (p < 0.05 for all). Only the decreases in the foveal DCP and choriocapillaris vascular density values were significant at the first week after vaccination (p < 0.05 for all).

CONCLUSION

The early changes detected after vaccination in this study suggest the possibility that autoimmune, vascular, and inflammatory diseases may simultaneously emerge in the early post-vaccination period or may be triggered after vaccination, or that the vaccine may unmask these diseases.

Descemet's membrane endothelial keratoplasty rejection after SARS-COV2 infection or vaccination: 2-year retrospective study

PURPOSE

To assess the incidence of Descemet's membrane endothelial keratoplasty (DMEK) rejection potentially associated with coronavirus disease 2019 (COVID-19) infection or vaccination, and its association with known rejection risk factors during the first two years of the pandemic.

METHODS

This retrospective study included patients with DMEK rejection between January 2020 and December 2021. Diagnostic criteria were based on symptoms, visual acuity, and other clinical assessments. Risk factors for graft rejection were considered, and a telephone survey was conducted to identify possible preceding COVID-19 infection or vaccination.

RESULTS

Of 58 patients, 44 were included. Six patients (14%) reported COVID-19 infection, with one immediate endothelial graft rejection (EGR) post-infection. After vaccine availability, 13 of 36 patients had EGR at an average of 2.7 months post-vaccination. Five (38%) had immediate EGR following vaccination, four of which had concomitant risk factors for rejection.

CONCLUSION

Although the risk of endothelial graft rejection (EGR) associated with COVID-19 infection or vaccination appears to be extremely low, there may be a causative relationship, especially in patients with pre-existing risk factors for EGR. A temporary increase in anti-rejection treatment following COVID-19 infection or vaccination is recommended, especially in patients with pre-existing risk factors, along with closer monitoring during the subsequent 4 to 8 weeks.

Vaccine-associated corneal graft rejection following SARS-CoV-2 vaccination: a CDC-VAERS database analysis

PURPOSE

To evaluate the cases of corneal graft rejection following SARS-CoV-2 vaccination reported to Centers for Disease Control and Prevention Vaccine Adverse Event Reporting System.

METHODS

A descriptive analysis of the demographics, clinical history and presentation was performed. We evaluated the correlation between the vaccines and duration of vaccine-associated graft rejection (VAR) onset following vaccination using a one-way analysis of variance test. A post hoc analysis was performed between VAR onset-interval following vaccination dose and vaccine type. Finally, a 30-day cumulative incidence analysis was performed to assess the risk of VAR in short term following different doses, vaccines and type of corneal transplantation.

RESULTS

A total of 55 eyes of 46 patients were diagnosed with VAR following vaccination with BNT162b2 (73.91%) and mRNA-1273 (26.09%). The mean age of the patients was 62.76±15.83 years, and 28 (60.87%) were female. The patients diagnosed with VAR had undergone penetrating keratoplasty (61.82%), Descemet membrane endothelial keratoplasty (12.73%), descemet stripping endothelial keratoplasty (18.18%), anterior lamellar keratoplasty (3.64%) and corneal limbal allograft transplantation (1.82%). The mean time for VAR since penetrating and endothelial keratoplasty was 8.42±9.23 years and 4.18±4.40 years, respectively. 45.65% of the cases of VAR were reported after the second dose of vaccine. The duration of VAR onset was significantly shorter after the second dose compared with the first and booster doses (p=0.0165) and in patients who underwent endothelial keratoplasty compared with penetrating keratoplasty (p=0.041).

CONCLUSIONS

This study outlines a possible temporal relationship between corneal graft rejection and SARS-CoV-2 vaccination. An earlier onset of VAR was observed in patients who had a history of endothelial keratoplasty and following the second dose of vaccination.

COVID-19 vaccination and corneal allograft rejection- a review

Aim

To provide a comprehensive literature review on the perceived correlation between COVID-19 vaccination and corneal allograft rejection, and to characterize risk factors, time course, graft outcomes and proposed immunological basis.

Methods

A literature review was conducted in August 2023 using 4 electronic databases: PubMed, EMBASE, MEDLINE and Scopus. Articles were sourced using key words associated with COVID-19 vaccination and corneal graft. All articles were screened for relevance by abstract review. Duplicates and articles related to COVID-19 infection were excluded. No time limits were set. Additional literature searches regarding cause of corneal graft rejection, rates of graft rejection associated with other vaccines and the cellular mechanism of rejection were also performed.

Results

262 articles were identified from the literature search. 37 papers were included in the analysis based on defined inclusion criteria. This consisted of systematic reviews (n=6), review articles (n=5), retrospective studies (n=3), case series (n=8), letter to the editor (n=1) and case reports (n= 14). The majority of reported allograft rejections were in penetrating keratoplasties. Risk factors for COVID-19 vaccination associated rejection were previous allograft rejection episodes, repeat grafts and penetrating keratoplasty. Most reported rejection episodes were mild and resolved with treatment. Notably, several studies reported nil increase in corneal allograft rejection episodes over the COVID-19 vaccination period. Rejection episodes are associated with a broad spectrum of other vaccines and the complete pathophysiology is undetermined.

Conclusion

Corneal allograft rejection appears to be a rare complication of COVID-19 vaccination most frequently observed in high-risk corneal transplants. The true extent of this correlation remains controversial; however, clinician awareness of this risk is essential to its mitigation. Patient counselling around symptom monitoring following vaccination and discussion around topical steroid prophylaxis may be prudent.

COVID and COVID vaccine-related corneal morbidity: A review

Systemic coronavirus disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has had several ocular consequences. Many vaccines have been developed against the disease, with adverse events being reported as well. Various ocular adverse events secondary to coronavirus disease 2019 (COVID-19) vaccines have also featured in literature in recent times. This review features the reported corneal-related effects of COVID infection and vaccination. These include direct effects on corneal grafts and unilateral or bilateral corneal melts. The compilation of reported experiences from across the world in this systematic review will help clinicians recognize the possible presentations, pathogenesis, and management of the same.

A lack of an association between COVID-19 vaccination and corneal graft rejection: results of a large multi-country population based study

PURPOSE

The aim of the study was to present the rates of corneal transplant rejection from 2018 to 2022 at both Moorfields Eye Hospital UK, and Ospedali Privati Forli (OPF) "Villa Igea", Italy and evaluate the purported association between COVID-19 vaccination and rejection.

METHODS

We performed a retrospective review of rejection cases presenting to the two units. Monthly rates were correlated against regional vaccination programme rates. At OPF, conditional Poisson regression model was employed to estimate the incidence risk ratio (IRR) of graft rejection following COVID-19 vaccination risk period compared with the control period.

RESULTS

Between January 2018 and March 2022, there were 471 (Moorfields), 95 (OPF) episodes of rejection. From the start of vaccination programme in the UK in late January 2021, the median number of graft rejections per month at Moorfields was 6 (range: 5-9), which was not significantly different to post-lockdown, pre-vaccination programme (March 2020-January 2021), p = 0.367. At OPF, the median rates of rejection before and after initiation of the vaccination programme were not significantly different (p = 0.124). No significant increase in incidence rate of rejection in the risk period following COVID-19 vaccination was found (IRR = 0.53, p = 0.71).

CONCLUSION

No notable increase in rates of transplant rejection was noted in year 2021 when COVID-19 vaccination was broadly implemented. The apparent temporal relationship between COVID-19 vaccination and corneal graft rejection highlighted in several case reports may not represent a causative association.

Evaluation of the Effect of İnfection and İmmunity on the Tear Film by Scheimpflug-Placido Disc Topography- A Case Control Study

PURPOSE

We aimed to compare the tear film stability of individuals who had recovered from coronavirus disease (COVID-19), that of individuals vaccinated against COVID-19 and that of healthy individuals in a control group.

METHODS

This study included 61 eyes of 61 post-COVID-19 patients, 63 eyes of 63 participants who had received at least two doses of the SARS-CoV-2 mRNA BNT162b2 (Pfizer-BioNTech) vaccine, and 57 eyes of healthy individuals in a control group. We compared the groups' tear film stability.

RESULTS

The mean non-invasive first tear break-up time (NIF-BUT) value was 4.1±2.7 seconds in the post-COVID-19 group, 4.7±2.9 seconds in the vaccinated group, and 5.8±2.8 seconds in the control group. This value was statistically significantly lower in the post-COVID-19 and vaccinated groups than in the control group (p= 0.007). The rate of superotemporal (ST) quadrant breakup, statistically significantly higher in the vaccinated group than in the other two groups (p=0.001). According to a qualitative examination of the results, at least one breakup occurred in 47 (77%) of the post-COVID-19 participants' eyes, 50 (79.4%) of the vaccinated group's eyes, and 33 (57.9%) of the control group's eyes. In terms of this qualitative value, the post-COVID-19 and vaccinated groups had significantly higher breakup rates than the control group (p=0.018).

CONCLUSIONS

Destabilization in the tear film was more common in both the post covid group and the vaccinated group. In addition to individuals who have post-Covid, we think that post-vaccination individuals should be followed closely in terms of ocular surface diseases.

Corneal Allograft Endothelial Rejection after Sinopharm COVID-19 Vaccination; Report of Six Cases

AIM

To report the clinical characteristics of six patients with corneal allograft endothelial rejection after COVID-19 vaccination with Sinopharm and to review the literature.

METHODS

This is a prospective case series describing corneal allograft rejection among subjects having received Sinopharm (BBIBP-CorV) vaccine, coming to cornea clinic at a university-based hospital (Rassoul Akram Hospital, Tehran, Iran) from September 2021 to March 2022 for regular follow-up examinations. Data on demographics, vaccination (based on vaccine card), and graft condition (based on recent examination and previous medical documents) were recorded.

RESULTS

Out of 54 eyes (46 patients), 6 eyes (6 patients) had corneal allograft endothelial rejection after 3 to 117 days, post-vaccination. Three out of six rejections occurred within two weeks following vaccination. All of them were male with the mean age of 53.00 ± 19.66 years. The graft type of all patients was penetrating keratoplasty (PKP). The adverse event developed on average at 40.67 ± 34.33 months after surgery. Four patients were under maintenance treatment by topical steroid at the time of vaccination. One also received systemic immunomodulatory medication. Four grafts ended up with partial or complete graft failure. One case had received two doses of vaccine before undergoing the second corneal graft transplantation.

CONCLUSION

COVID-19 vaccination with Sinopharm may trigger corneal allograft endothelial rejection even in individuals with low-risk graft and under maintenance topical and/or systemic immunomodulatory medications.

Can COVID-19 Vaccines Induce Premature Non-Communicable Diseases: Where Are We Heading to?

According to the WHO, as of January 2023, more than 850 million cases and over 6.6 million deaths from COVID-19 have been reported worldwide. Currently, the death rate has been reduced due to the decreased pathogenicity of new SARS-CoV-2 variants, but the major factor in the reduced death rates is the administration of more than 12.8 billion vaccine doses globally. While the COVID-19 vaccines are saving lives, serious side effects have been reported after vaccinations for several premature non-communicable diseases (NCDs). However, the reported adverse events are low in number. The scientific community must investigate the entire spectrum of COVID-19-vaccine-induced complications so that necessary safety measures can be taken, and current vaccines can be re-engineered to avoid or minimize their side effects. We describe in depth severe adverse events for premature metabolic, mental, and neurological disorders; cardiovascular, renal, and autoimmune diseases, and reproductive health issues detected after COVID-19 vaccinations and whether these are causal or incidental. In any case, it has become clear that the benefits of vaccinations outweigh the risks by a large margin. However, pre-existing conditions in vaccinated individuals need to be taken into account in the prevention and treatment of adverse events.

Corneal Adverse Events Associated with SARS-CoV-2/COVID-19 Vaccination: A Systematic Review

Vaccines against coronavirus disease 2019 (COVID-19) have played an important global role in reducing morbidity and mortality from COVID-19 infection. While the benefits of vaccination greatly outweigh the risks, adverse events do occur. Non-ocular adverse effects of the vaccines have been well-documented, but descriptions of ophthalmic effects remain limited. This systematic review aims to provide an overview of reported cases of corneal adverse events after receiving vaccination against COVID-19 and to compile existing clinical data to bring attention to these phenomena. Our review discusses corneal graft rejection, including proposed mechanisms, herpetic keratitis, and other reported corneal complications. Ophthalmologists and primary care physicians should be aware of such possible associations.

New onset of acute uveitis following COVID-19 vaccination

PURPOSE

This study reported 11 cases of new-onset acute uveitis following coronavirus disease 2019 (COVID-19) vaccination.

METHODS

This retrospective observational case study included 11 eyes of 11 patients with acute uveitis after the COVID-19 vaccination. We only included patients with new-onset uveitis. The medical records of the patients from January 2021 to January 2022 were reviewed.

RESULTS

The mean age of the participants was 51.81 years, and all patients demonstrated anterior chamber reaction with keratic precipitates in the affected eye. The mean duration between vaccination and uveitis was 8.27 days. Seven patients developed uveitis after receiving the second dose of vaccination, and four developed uveitis after receiving the third dose of vaccination. Five patients showed posterior synechiae, and three patients showed hypopyon. After treatment with topical 1% prednisolone acetate eye drops and systemic prednisolone, inflammation was adequately controlled and quickly resolved.

CONCLUSIONS

COVID-19 vaccination with messenger RNA and viral vector vaccines may cause acute anterior uveitis. Although initially severe, uveitis responded well to steroid therapy with no visual impairment.

Corneal Complications after COVID-19 Vaccination: A Systemic Review

Multiple vaccines are now being used across the world, and several studies have described cases of corneal graft rejection following the administration of the COVID-19 vaccine. The purpose of this article is to review the corneal adverse event that occurred following COVID-19 vaccine administration. The literature search was conducted in March 2022 using MEDLINE, PubMed, and the Cochrane Database of Systematic Reviews. A total of 27 articles, including 37 cases, have documented corneal adverse events that occurred following COVID-19 vaccination. The mean age was 60 ± 14.9 years (range, 27-83 years). The most common events were acute corneal graft rejection (n = 21, 56.8%), followed by herpes zoster ophthalmicus (n = 11, 29.7%) and herpes simplex keratitis (n = 2, 5.4%). The mean time from vaccination to the event was 10 ± 8.5 days (range, 1-42 days) after the first or second dose of vaccine. All patients with corneal graft rejection, immune-mediated keratolysis, and peripheral ulcerative keratitis (PUK) (n = 24, 64.9%) were managed topically with or without oral corticosteroids. Patients with herpes zoster ophthalmicus and herpes simplex keratitis were managed with oral antiviral agents. Two patients received penetrating keratoplasty due to keratolysis after invalid topical treatment. Disease resolution was noted in 29 patients (78.3%), whereas 3 (8.1%) had persistent corneal edema after graft rejection, 1 (2.7%) had corneal infiltration after HZO, and 4 (10.8%) were not mentioned in the articles. Corneal adverse events could occur after COVID-19 vaccination. After timely treatment with steroids or antiviral agents, most of the events were mild and had a good visual outcome. Administrating or increasing steroids before vaccination may be useful for the prevention of corneal graft rejection. However, the prophylactic use of antiviral treatments in patients with a herpes viral infection history is not recommend.

COVID-19 Vaccine-Associated Ocular Adverse Effects: An Overview

BACKGROUND

To address the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), vaccination efforts were initiated across the globe in December 2020 and are continuing. We report the onset interval and clinical presentations of ocular adverse effects following SARS-CoV-2 vaccination.

METHODS

For this narrative review, articles in the English language, published between 1 January 2020 to 1 September 2022, were included to formulate a list of the reported ocular adverse effects of different COVID-19 vaccines.

RESULTS

During this period, ocular adverse effects have been reported with BNT162b2 (Pfizer), mRNA-1273 (Moderna), AZD-1222 (AstraZeneca), and Ad26.COV2.S (Johnson & Johnson) vaccines. Endothelial graft rejection, herpes simplex virus keratitis, herpes zoster ophthalmicus, anterior uveitis, eyelid edema, purpuric rashes, ischemic optic neuropathy, and cranial nerve palsies were the most reported with BNT163b2. Retinal hemorrhages, vascular occlusions, and angle closure glaucoma were the most reported with AZD-1222. Most of the ocular adverse effects reported in the literature had a good to fair prognosis with appropriate management.

CONCLUSIONS

Evidence regarding the ocular adverse effects does not outweigh the benefits of SARS-CoV-2 vaccination in patients with pre-existing systemic or ophthalmic diseases. This review provides insights into the possible temporal association between reported ocular adverse events and SARS-CoV-2 vaccines; however, further investigations are required to identify the link between potential causality and pathological mechanisms.

COVID-19 Vaccination May Not Increase Rates of Corneal Graft Rejection

PURPOSE

The aim of the study was to present the rates of rejection from 2018 to 2021 and evaluate the purported association between COVID-19 vaccination and corneal graft rejection.

METHODS

Cases of corneal graft rejection diagnosed between January 2018 and December 2021 were reviewed. The conditional Poisson regression model of the self-controlled case series method was used to estimate the incidence risk ratio of graft rejection after COVID-19 vaccination risk period compared with the control period. Based on outcomes of eyes that underwent keratoplasty from January 2018 to December 2020, Cox proportional hazard models were fitted with previous COVID-19 vaccination as a time-varying covariate.

RESULTS

Over the past 4 years, the annual tally of diagnosed cases of graft rejection (19 cases in year 2018, 19 cases in year 2019, 21 cases in year 2020, and 18 cases in year 2021) has remained relatively stable. Using the conditional Poisson regression analysis, no significant increase in the incidence rate of rejection in the risk period after COVID-19 vaccination was found (incidence risk ratio = 0.56, 95% confidence interval [CI] = 0.13-2.28, P = 0.70). Fitted as a time-varying covariate, previous COVID-19 vaccination was not associated with graft rejection in both unadjusted (hazard ratio =0.77, 95% CI = 0.29-5.46, P = 0.77) and adjusted Cox models (hazard ratio = 0.75, 95% CI = 0.10-5.52, P = 0.78).

CONCLUSIONS

No notable increase in rates of corneal graft rejection was noted in year 2021 when COVID-19 vaccination was broadly implemented. The apparent temporal relationship between COVID vaccination and corneal graft rejection may not represent a causative association.

Solid Organ Rejection following SARS-CoV-2 Vaccination or COVID-19 Infection: A Systematic Review and Meta-Analysis

Background: Solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection is extremely rare but can occur. T-cell recognition of antigen is the primary and central event that leads to the cascade of events that result in rejection of a transplanted organ. Objectives: To describe the results of a systematic review for solid organ rejections following SARS-CoV-2 vaccination or COVID-19 infection. Methods: For this systematic review and meta-analysis, we searched Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines for studies on the incidence of solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection, published from 1 December 2019 to 31 May 2022, with English language restriction. Results: One hundred thirty-six cases from fifty-two articles were included in the qualitative synthesis of this systematic review (56 solid organs rejected post-SARS-CoV-2 vaccination and 40 solid organs rejected following COVID-19 infection). Cornea rejection (44 cases) was the most frequent organ observed post-SARS-CoV-2 vaccination and following COVID-19 infection, followed by kidney rejection (36 cases), liver rejection (12 cases), lung rejection (2 cases), heart rejection (1 case) and pancreas rejection (1 case). The median or mean patient age ranged from 23 to 94 years across the studies. The majority of the patients were male (n = 51, 53.1%) and were of White (Caucasian) (n = 51, 53.7%) and Hispanic (n = 15, 15.8%) ethnicity. A total of fifty-six solid organ rejections were reported post-SARS-CoV-2 vaccination [Pfizer-BioNTech (n = 31), Moderna (n = 14), Oxford Uni-AstraZeneca (n = 10) and Sinovac-CoronaVac (n = 1)]. The median time from SARS-CoV-2 vaccination to organ rejection was 13.5 h (IQR, 3.2–17.2), while the median time from COVID-19 infection to organ rejection was 14 h (IQR, 5–21). Most patients were easily treated without any serious complications, recovered and did not require long-term allograft rejection therapy [graft success (n = 70, 85.4%), graft failure (n = 12, 14.6%), survived (n = 90, 95.7%) and died (n = 4, 4.3%)]. Conclusion: The reported evidence of solid organ rejections post-SARS-CoV-2 vaccination or COIVD-19 infection should not discourage vaccination against this worldwide pandemic. The number of reported cases is relatively small in relation to the hundreds of millions of vaccinations that have occurred, and the protective benefits offered by SARS-CoV-2 vaccination far outweigh the risks.

Characteristics and Clinical Ocular Manifestations in Patients with Acute Corneal Graft Rejection after Receiving the COVID-19 Vaccine: A Systematic Review

This study aimed to determine the characteristics and clinical ocular manifestations of acute corneal graft rejection after coronavirus disease 2019 (COVID-19) vaccination. We conducted an online search of the PubMed and EMBASE databases. Data on recipients’ characteristics, corneal transplantation types, interval between vaccination and allograft rejection, clinical manifestations, and graft rejection medication were extracted. Thirteen articles on 21 patients (23 eyes) with acute corneal graft rejection after COVID-19 vaccination, published between April and December 2021, were included. The median (interquartile range) age at the onset of rejection was 68 (27–83) years. Types of transplantation included penetrating keratoplasty (12 eyes), Descemet membrane endothelial keratoplasty (six eyes), Descemet stripping automated endothelial keratoplasty (four eyes), and living-related conjunctival-limbal allograft (one eye). The interval between vaccination and rejection ranged from 1 day to 6 weeks. Corneal edema was the leading clinical manifestation (20 eyes), followed by keratic precipitates (14 eyes) and conjunctival or ciliary injection (14 eyes). Medications included frequently applied topical corticosteroids (12 eyes), followed by a combination of topical and oral corticosteroids (four eyes). In addition, the clinical characteristics of corneal allograft rejection after COVID-19 vaccination were identified. Corneal transplant recipients may require further vaccination, necessitating appropriate management and treatment.

Acute Rejection Following COVID-19 Vaccination in Penetrating Keratoplasty in a Young Male - A Case Report and Review of Literature

PURPOSE

To report a case of a boy with acute keratoplasty rejection manifesting 12 days after receiving BNT162b2 messenger RNA (mRNA) vaccine for COVID-19.

STUDY DESIGN

A case report.

RESULTS

A 15-year-old boy with a history of penetrating keratoplasty due to acanthamoeba keratitis developed corneal decompensation 12 days after BNT162b2 messenger RNA vaccine for COVID-19 disease. One-week treatment with topical Dexamethasone 2% eye drops resulted in a complete resolution of corneal edema.

CONCLUSIONS

This case suggests that BNT162b2 messenger RNA (mRNA) vaccine can be associated with acute keratoplasty rejection in children, which responds completely to topical steroids. Ophthalmologists should be aware of this risk of cornea decompensation after COVID-19 vaccine in children who received a cornea transplant.

Acute corneal allograft rejection following SARS-CoV-2 vaccination-A systematic review

All documented cases of acute corneal allograft rejection following SARS-CoV-2 vaccination were examined, to characterize possible risk factors and graft outcomes. Comprehensive search (4 electronic databases: PubMed, CENTRAL, ClinicalTrials.gov, Google Scholar, plus manual search in articles' reference lists) until March 1st 2022 to identify studies reporting acute corneal allograft rejection following SARS-CoV-2 vaccination; study protocol was developed in line with PRISMA statement. We analysed demographics, allograft type, rejection prophylaxis regime at the time of vaccination, transplantation-to-vaccination time (G-Vt), vaccination-to-immune reaction onset time (V-Rt), management, best-corrected visual acuity before and after rejection, and graft survival. Of 169 titles/abstracts screened, 16 studies (n  = 36 eyes) met the inclusion criteria. Fourteen eyes (38.9%) had received >1 graft, and 11.1% of cases had history of immune reactions; 52.9% of cases occurred after the first dose. Median (P25-P75) G-Vt was 48 (10-78) months; median V-Rt was 9 (7-14) days. In eyes with resolved rejection, median time-to-resolution was 3 (1-4) weeks. Four eyes (11.1%) had partial resolution of corneal decompensation, and 5 grafts (13.9%) failed. Acute corneal allograft rejection after SARS-CoV-2 vaccination is a rare event, but may occur any time post-keratoplasty. Early recognition and prompt, aggressive treatment is warranted to optimize vision and graft survival. Well-known risk factors for rejection may be confounding factors, including the high proportion of cases with a history of previous grafts and the rejection prophylaxis regimes at the time of vaccination. Increasing immunosuppressants in the peri-vaccination period may decrease the risk of immune reactions, especially in high-risk cases.

Impact of vaccination on keratoplasty

PURPOSE OF REVIEW

Corneal graft rejection has been reported after coronavirus disease 2019 (COVID-19) vaccination. The purpose of this review is to evaluate the literature regarding corneal graft rejection after vaccination, including rejection rates and risk factors. We aim to create a framework to identify patients who are at higher risk for graft rejection and may warrant consideration of prophylactic interventions.

RECENT FINDINGS

Graft rejection has been reported following administration of mRNA, viral vector, and inactivated whole-virion COVID-19 vaccines. Most cases had additional risk factors associated with rejection. Vaccination increases circulation of proinflammatory cytokines, CD4+ and CD8+ T-cell responses, and antispike neutralizing antibody, all of which may contribute to graft rejection. Two prospective studies have found no relationship between recent vaccination and rejection but 20% of cornea specialists report to have seen a vaccine-associated rejection and 22% recommend delaying vaccination in certain circumstances. Many specialists recommend prophylactic topical corticosteroids before and after vaccination to mitigate rejection risk but there is no evidence to support this practice on a wider scale.

SUMMARY

Our framework identified 96.8% of penetrating keratoplasty patients with vaccine-associated rejection as higher risk. Further research is needed in order to develop evidence-based guidelines.

Unilateral Acute Central Serous Chorioretinopathy with Inactivated Coronavirus Disease 2019 Vaccination: A Case Report and Review of Literature

Purpose

To report unilateral acute-onset central serous chorioretinopathy (CSC) following vaccination with inactivated coronavirus disease 2019 (COVID-19) vaccine in a healthy patient.

Methods

Case report and review of literature.

Results

A 39-year-old male was referred with sudden-onset, painless, unilateral blurred vision in the right eye. His first dose of the Sinopharm vaccine was injected 2 days before. A complete ocular examination revealed central subretinal fluid (SRF) accumulation in favor of CSC in the right eye. Systemic workup disclosed no previous COVID-19 infection or any systemic involvement. After 3 weeks, SRF decreased remarkably without treatment.

Conclusions

It is proposed that CSC development can be an ocular adverse effect of COVID-19 vaccination, although it is infrequent. Ophthalmologists should be aware of the possible association between COVID-19 vaccination and ocular adverse effects, but vaccination is the best effectual measure against COVID-19.

Acute Unilateral Central Serous Chorioretinopathy after Immunization with Pfizer-BioNTech COVID-19 Vaccine: A Case Report and Literature Review

INTRODUCTION

A 43-year-old Caucasian male presented to our ophthalmology clinic with blurry vision and metamorphopsia in his right eye, 24 hours after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine.

METHODS

Clinical examination and imaging tests were consistent with acute unilateral central serous chorioretinopathy (CSCR) that completely resolved after 2 months without any treatment. He had no significant ophthalmic or medical history. He also lacked the classical risk factors for CSCR such as recent psychosocial stressors, Type-A personality traits, history of exogenous steroid use, connective tissue disorders and obstructive sleep apnea.

RESULTS

This appears to be only the second reported case of CSCR, temporally associated with a recombinant COVID-19 mRNA vaccine. We also present a summary of published reports demonstrating intraocular complications associated with the novel recombinant COVID-19 mRNA vaccines.

CONCLUSION

Findings in this report should not deter COVID-19 vaccinations given the rarity of aforementioned ocular complications and the greater benefit of protection from COVID-19 infection. Medical practitioners, however, should remain mindful of potential ocular complications, given the greater likelihood of occurrence with increasing vaccination booster rates.

Bilateral Panuveitis with Occlusive Vasculitis following Coronavirus Disease 2019 Vaccination

PURPOSE

To report a case of bilateral panuveitis and occlusive vasculitis following COVID-19 vaccination.

STUDY DESIGN

Case report.

RESULTS

A 41-year-old otherwise healthy male presented with progressive vision loss and floaters starting 48 hours after a first dose of COVID-19 vaccine. Examination initially showed bilateral anterior uveitis, but this evolved into bilateral panuveitis with occlusive vasculitis despite topical corticosteroids over two weeks. The patient underwent extensive testing for other etiologies which were excluded. He was successfully treated with a gradual taper of topical and systemic corticosteroids leading to improvement of signs and symptoms. Follow-up is maintained for observation of avascular zones with possible neovascularization which could require laser as needed.

CONCLUSIONS

The temporal association between vaccine and presentation makes this a plausible etiology. This remains a rare adverse event, but clinicians should be aware of this possibility to include it in their differential diagnosis when confronted with idiosyncratic ocular presentations.

Ocular Complications Following Vaccination for COVID-19: A One-Year Retrospective

Vaccination efforts as a mitigation strategy in the corona virus disease 2019 (COVID-19) pandemic are fully underway. A vital component of understanding the optimal clinical use of these vaccines is a thorough investigation of adverse events following vaccination. To date, some limited reports and reviews have discussed ocular adverse events following COVID-19 vaccination, but a systematic review detailing these reports with manifestations and clinical courses as well as proposed mechanisms has yet to be published. This comprehensive review one-year into vaccination efforts against COVID-19 is meant to furnish sound understanding for ophthalmologists and primary care physicians based on the existing body of clinical data. We discuss manifestations categorized into one of the following: eyelid, orbit, uveitis, retina, vascular, neuro-ophthalmology, ocular motility disorders, and other.

Stromal rejection in penetrating keratoplasty following COVID-19 vector vaccine (Covishield) - A case report and review of literature

Endothelial rejection has been described following both m-RNA and vector-based vaccines for COVID-19. There is one case report of a stromal rejection described following influenza vaccination. We report a case of stromal rejection following vector-based COVID-19 vaccination, which might be the first case reported so far.

After the Storm: Ophthalmic Manifestations of COVID-19 Vaccines

Several COVID-19 vaccines have been developed and approved for use around the world from December 2020, to combat the pandemic caused by the novel SARS-CoV-2 virus. Several ophthalmic manifestations of the COVID-19 vaccines have been reported by ophthalmologists. This review was undertaken to recognize, encourage active reporting and determine the pathogenesis and time of appearance for better awareness and understanding of the ophthalmic manifestations of COVID-19 vaccines. A literature search was performed for publications on the ophthalmic manifestations of COVID-19 vaccines between January 1, 2021 and November 7, 2021. 23 case reports, 17 letters to editors, 3 ophthalmic images, 4 brief communications, 4 retrospective cohort studies and 2 case control studies were included. Posterior segment, including the uvea, choroid and retinal vasculature, was most commonly affected and the reported clinical features developed at a median of four days from the time of vaccination. The possible mechanisms include molecular mimicry of the vaccine components with host ocular tissues, antigen-specific cell and antibody-mediated hypersensitivity reactions to viral antigens and adjuvants present in the vaccines. The causal relationship of the ocular signs and symptoms and COVID-19 vaccines has not been established and requires long-term and large multicentre data. Most of the reported manifestations are mild, transient and adequately treated when diagnosed and managed early. The benefits of COVID-19 vaccination outweighs the reported rare adverse events and should not be a deterrent to vaccination.