1
|
Hwang S, Kang SW, Choi J, Park KA, Lim DH, Shin JY, Kang D, Cho J, Kim SJ. COVID-19 vaccination and ocular adverse events: a self-controlled case series study from the entire South Korean population. Am J Ophthalmol 2024:S0002-9394(24)00376-3. [PMID: 39179130 DOI: 10.1016/j.ajo.2024.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE This study aimed to assess the risk of ocular adverse events, including retinal artery occlusion (RAO), retinal vein occlusion (RVO), non-infectious uveitis (NIU), non-infectious scleritis (NIS), optic neuritis (ON), ischemic optic neuropathy (ION), and ocular motor cranial nerve palsy (OMCNP), following coronavirus disease 2019 (COVID-19) vaccination. DESIGN Population-based self-controlled case series METHODS: This study utilized nationwide claims and vaccination data provided by the Korea National Health Insurance Service and Korea Disease Control and Prevention Agency. From the entire South Korean population of 52 million individuals, patients with incident RAO, RVO, anterior NIU, non-anterior NIU, NIS, ON, ION, or OMCNP between January 2021 and March 2022 were included. The post-vaccination risk period was defined as up to 56 days after COVID-19 vaccination. The relative incidence rate ratios (IRRs) for RAO, RVO, anterior NIU, non-anterior NIU, NIS, ON, ION, and OMCNP during the risk periods were measured using conditional Poisson regression. RESULTS The study included 6,590, 70,120, 137,958, 17,921, 15,492, 2,039, 49,089, and 11,312 cases of incident RAO, RVO, anterior NIU, non-anterior NIU, NIS, ON, ION, and OMCNP, respectively. The IRRs (95% confidence interval) during the early risk period (0-28 days) were 0.95 (0.88-1.01), 0.96 (0.94-0.98), 0.93 (0.91-0.94), 0.93 (0.89-0.96), 0.96 (0.92-1.01), 1.04 (0.92-1.18), 0.98 (0.95-1.00), and 0.91 (0.86-0.96), respectively. In the late risk period (29-56 days), the IRRs were 0.96 (0.89-1.03), 0.93 (0.91-0.96), 0.96 (0.95-0.98), 1.00 (0.95-1.04), 0.96 (0.91-1.01), 1.00 (0.87-1.15), 1.01 (0.98-1.04), and 0.95 (0.90-1.01), respectively. CONCLUSION COVID-19 vaccination did not increase the risk of incident RAO, RVO, anterior NIU, non-anterior NIU, NIS, ON, ION, or OMCNP during the post-vaccination period.
Collapse
Affiliation(s)
- Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jaehwan Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Ju-Young Shin
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea; School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea; Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea; Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
2
|
Alsalman B, AlBloushi AF, Alzuabi AK, Al Tawil L. Uveitis following COVID-19 vaccination in the pediatric population: Experience at a tertiary referral hospital. J Fr Ophtalmol 2024; 47:104265. [PMID: 39106557 DOI: 10.1016/j.jfo.2024.104265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/02/2024] [Accepted: 05/18/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE To determine the incidence and outcomes of uveitis following coronavirus (COVID-19) vaccination in the pediatric population. METHODS A case series of all patients under the age of 18years diagnosed with uveitis within 28days of COVID-19 vaccination. RESULTS Out of 33 patients under the age of 18years who presented with uveitis from July 2021 until May 2022, eight (24.2%) developed uveitis following COVID-19 vaccination within 28days. Four had a previous history of uveitis. The mean time interval from COVID-19 vaccination to uveitis diagnosis was 14.75days. The most common anatomic diagnosis was anterior uveitis in four children, followed by panuveitis in two and posterior uveitis in two. Seven children were treated with systemic steroids/immunomodulatory agents. Improved or unaffected visual acuity was noted in all children at the final follow-up. CONCLUSION The pediatric population may demonstrate uveitis following COVID-19 vaccination. All children were treated successfully, and good final visual acuity was achieved.
Collapse
Affiliation(s)
- B Alsalman
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A F AlBloushi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - A K Alzuabi
- Department of Ophthalmology, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - L Al Tawil
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Ng HW, Scott DAR, Danesh-Meyer HV, Smith JR, McGhee CN, Niederer RL. Ocular manifestations of COVID-19. Prog Retin Eye Res 2024; 102:101285. [PMID: 38925508 DOI: 10.1016/j.preteyeres.2024.101285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024]
Abstract
There is an increasing body of knowledge regarding how COVID-19 may be associated with ocular disease of varying severity and duration. This article discusses the literature on the ocular manifestations associated with COVID-19, including appraisal of the current evidence, suggested mechanisms of action, associated comorbidities and risk factors, timing from initial infection to diagnosis and clinical red flags. The current literature primarily comprises case reports and case series which inevitably lack control groups and evidence to support causality. However, these early data have prompted the development of larger population-based and laboratory studies that are emerging. As new data become available, a better appraisal of the true effects of COVID-19 on the eye will be possible. While the COVID-19 pandemic was officially declared no longer a "global health emergency" by the World Health Organization (WHO) in May 2023, case numbers continue to rise. Reinfection with different variants is predicted to lead to a growing cumulative burden of disease, particularly as more chronic, multi-organ sequelae become apparent with potentially significant ocular implications. COVID-19 ocular manifestations are postulated to be due to three main mechanisms: firstly, there is a dysregulated immune response to the initial infection linked to inflammatory eye disease; secondly, patients with COVID-19 have a greater tendency towards a hypercoagulable state, leading to prothrombotic events; thirdly, patients with severe COVID-19 requiring hospitalisation and are immunosuppressed due to administered corticosteroids or comorbidities such as diabetes mellitus are at an increased risk of secondary infections, including endophthalmitis and rhino-orbital-mucormycosis. Reported ophthalmic associations with COVID-19, therefore, include a range of conditions such as conjunctivitis, scleritis, uveitis, endogenous endophthalmitis, corneal graft rejection, retinal artery and vein occlusion, non-arteritic ischaemic optic neuropathy, glaucoma, neurological and orbital sequelae. With the need to consider telemedicine consultation in view of COVID-19's infectivity, understanding the range of ocular conditions that may present during or following infection is essential to ensure patients are appropriately triaged, with prompt in-person ocular examination for management of potentially sight-threatening and life-threatening diseases.
Collapse
Affiliation(s)
- Hannah W Ng
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, New Zealand
| | - Daniel A R Scott
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, New Zealand
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, New Zealand
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Charles Nj McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, New Zealand.
| |
Collapse
|
4
|
Chen M, Zhang Y, Yao Y, Huang Y, Jiang L. Mendelian randomization supports causality between COVID-19 and glaucoma. Medicine (Baltimore) 2024; 103:e38455. [PMID: 38875430 PMCID: PMC11175937 DOI: 10.1097/md.0000000000038455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
To determine whether there is a causal relationship between Corona Virus Disease 2019 (COVID-19) and glaucoma, a 2-sample Mendelian Randomization (MR) design was applied with the main analysis method of inverse-variance-weighted. The reliability of the results was checked using the heterogeneity test, pleiotropy test, and leave-one-out method. Four sets of instrumental variables (IVs) were used to investigate the causality between COVID-19 and glaucoma risk according to data from the IEU Genome Wide Association Study (GWAS). The results showed that 2 sets of COVID-19(RELEASE) were significantly associated with the risk of glaucoma [ID: ebi-a-GCST011071, OR (95% CI) = 1.227 (1.076-1.400), P = .002259; ID: ebi-a-GCST011073: OR (95% CI) = 1.164 (1.022-1.327), P = .022450; 2 sets of COVID-19 hospitalizations were significantly associated with the risk of glaucoma (ID: ebi-a-GCST011081, OR (95% CI) = 1.156 (1.033-1.292), P = .011342; ID: ebi-a-GCST011082: OR (95% CI) = 1.097 (1.007-1.196), P = .034908)]. The sensitivity of the results was acceptable (P > .05) for the 3 test methods. In conclusion, this MR analysis provides preliminary evidence of a potential causal relationship between COVID-19 and glaucoma.
Collapse
Affiliation(s)
- Maolin Chen
- Department of Pharmacy, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Yinhui Zhang
- Department of Pharmacy, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Yu Yao
- Department of Ophthalmology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
| | - Yilan Huang
- Department of Pharmacy, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Longyang Jiang
- Department of Pharmacy, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- School of Pharmacy, Southwest Medical University, Luzhou, China
| |
Collapse
|
5
|
Seo EJ, Jung MS, Lee K, Kim KT, Choi MY. Ischemic and Inflammatory Ocular Adverse Events Following Different Types of Vaccination for COVID-19 and Their Incidence Analysis. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:203-211. [PMID: 38622066 PMCID: PMC11175981 DOI: 10.3341/kjo.2023.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
PURPOSE To evaluate the ocular adverse event (OAE) and the incidence rate that can occur after the COVID-19 vaccination. METHODS Patients who visited with an ophthalmologic diagnosis within a month of COVID-19 vaccination were retrospectively analyzed. OAEs were categorized as ischemia and inflammation by their presumed pathogenesis and were compared by types of vaccine: messenger RNA (mRNA) and viral vector vaccine. The crude incidence rate was calculated using data from the Korea Disease Control and Prevention Agency. RESULTS Twenty-four patients with OAEs after COVID-19 vaccination were reviewed: 10 patients after mRNA and 14 after viral vector vaccine. Retinal vein occlusion (nine patients) and paralytic strabismus (four patients) were the leading diagnoses. Ischemic OAE was likely to occur after viral vector vaccines, while inflammatory OAE was closely related to mRNA vaccine (p = 0.017). The overall incidence rate of OAE was 5.8 cases per million doses: 11.5 per million doses in viral vector vaccine and 3.4 per million doses in mRNA vaccine. CONCLUSIONS OAEs can be observed shortly after the COVID-19 vaccination, and their category was different based on the types of vaccine. The information and incidence of OAE based on the type of vaccine can help monitor patients who were administered the COVID-19 vaccine.
Collapse
Affiliation(s)
- Eoi Jong Seo
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Moon Sun Jung
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kibum Lee
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyung Tae Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Mi Young Choi
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| |
Collapse
|
6
|
Scott DAR, Niederer RL. Punctate Inner Choroidopathy (PIC) disease recurrence with inflammatory choroidal neovascular membrane (iCNVM) post-COVID-19 vaccine. Eur J Ophthalmol 2024:11206721241257969. [PMID: 38794849 DOI: 10.1177/11206721241257969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
PURPOSE To report a recurrence of punctate inner choroidopathy (PIC) with an inflammatory choroidal neovascular membrane (iCNVM) after the Pfizer-BioNTech COVID-19 vaccine. METHODS Case report. RESULTS A 38-year-old female with a history of myopia and previous episodes of PIC and iCNVM presented with distorted vision in her right eye, seven days after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine. The patient exhibited active PIC lesions with iCNVM confirmed on multimodal imaging. Treatment with a combination of oral corticosteroids and intravitreal anti-VEGF injection led to disease resolution. Subsequent COVID-19 vaccinations, administered while the patient was immunosuppressed, did not lead to disease relapse. However, relapse occurred following the fourth COVID-19 vaccine, when the patient was not immune suppressed. CONCLUSION This case highlights the potential risk of PIC disease relapse following COVID-19 vaccination. Further research is needed to investigate the relationship between COVID-19 vaccination and PIC exacerbation, as well as to determine optimal management strategies in this population, including close observation and consideration of prophylactic immune suppression at the time of COVID-19 vaccine for high-risk individuals.
Collapse
Affiliation(s)
- Daniel Andrew Richard Scott
- Te Whatu Ora Health New Zealand Te Toka Tumai Auckland, Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
- University of Auckland, Faculty of Medical and Health Sciences, Department of Ophthalmology, Auckland, New Zealand
| | - Rachael Louise Niederer
- Te Whatu Ora Health New Zealand Te Toka Tumai Auckland, Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand
- University of Auckland, Faculty of Medical and Health Sciences, Department of Ophthalmology, Auckland, New Zealand
| |
Collapse
|
7
|
Salh D, Pinto A, Freund P. Bilateral non-arteritic posterior ischaemic optic neuropathy following COVID-19 vaccination. BMJ Case Rep 2024; 17:e256860. [PMID: 38355209 PMCID: PMC10868318 DOI: 10.1136/bcr-2023-256860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
We report a case of bilateral posterior ischaemic optic neuropathy, which followed vaccination with ChAdOx1 nCoV-19 for COVID-19 prophylaxis. A man in his early 60s was initially assessed for bilateral acute vision loss following 3 days of frontal headaches. The patient denied any other preceding visual concerns or symptoms of giant cell arteritis. The patient received his first dose of the ChAdOx1 nCoV-19 vaccination 10 days before the onset of his symptoms.At initial presentation, visual acuity was counting fingers bilaterally. Blood work found normal erythrocyte sedimentation rate (6 mm/hour) and C reactive protein (<5 mg/L) as well as a negative infectious and autoimmune serology. He was negative for COVID-19 with PCR testing. Diffusion-weighted MRI showed restricted diffusion along both optic nerves. After 5 months, the patient's visual acuity remained counting fingers bilaterally with pale optic nerves. Isolated bilateral posterior ischaemic optic neuropathy has not been reported in association with the ChAdOx1 nCoV-19 vaccine.
Collapse
Affiliation(s)
- Dominique Salh
- Ophthalmology and Visual Sciences, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Ashlyn Pinto
- Ophthalmology and Visual Sciences, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Paul Freund
- Clarity Eye Institute, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Negretti GS, Zeiger JS, Cherkas E, Shields CL. Posterior scleritis following COVID-19 vaccination or infection simulating uveal melanoma in 8 consecutive patients. Eye (Lond) 2024; 38:185-191. [PMID: 37422535 PMCID: PMC10764359 DOI: 10.1038/s41433-023-02656-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVES To determine clinical features and outcomes of posterior scleritis masquerading as uveal melanoma following vaccination against COVID-19 and/or COVID-19 infection. SUBJECTS/METHODS All patients with posterior scleritis referred to our service to rule out intraocular tumour between February 2021 and June 2022, who previously had COVID-19 vaccination and/or infection (n = 8). A retrospective detailed review of patient charts and imaging was carried out. RESULTS Previous COVID-19 vaccination was documented in 6 patients (75%) and previous COVID-19 infection and vaccination in 2 patients (25%). Demographic features included mean age of 59 years (median 68, range 5-86 years), white race (n = 7, 87%), and male sex (n = 5, 63%). Mean visual acuity at presentation was 0.24 LogMAR (median 0.18, range 0.0-0.70). The main presenting symptom was blurred vision with pain (n = 5, 63%). Features that suggested scleritis and not uveal melanoma included pain (n = 6, 75%), anterior scleritis (n = 3, 38%), disc oedema (n = 1, 13%), choroidal detachment (n = 3, 38%), choroidal folds (n = 3, 38%), diffusely thickened scleral wall on ultrasonography (n = 2, 25%), Tenon's oedema (n = 5, 63%), and scleral nodule with medium/high internal reflectivity on ultrasonography (n = 4, 50%). Follow-up information at mean of 2 months (range 0.25-7 months) revealed visual acuity at date last seen was mean 0.30 LogMAR (median 0.29, range 0.0-0.54). By 2 months, resolution of "tumour" was noted in 5/6 (83%) patients with follow-up. CONCLUSIONS Posterior scleritis following COVID-19 vaccination and/or infection can masquerade as choroidal melanoma. At 2 months duration, partial or complete resolution of features with minimal visual consequence was noted.
Collapse
Affiliation(s)
- Guy S Negretti
- Shields and Shields, MD, PC, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer S Zeiger
- Shields and Shields, MD, PC, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elliot Cherkas
- Shields and Shields, MD, PC, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
- Casey Eye Institute, OHSU, Portland, OR, USA
| | - Carol L Shields
- Shields and Shields, MD, PC, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA.
| |
Collapse
|
9
|
Singh RB, Li J, Parmar UPS, Jeng BH, Jhanji V. Vaccine-associated corneal graft rejection following SARS-CoV-2 vaccination: a CDC-VAERS database analysis. Br J Ophthalmol 2023; 108:17-22. [PMID: 36575625 DOI: 10.1136/bjo-2022-322512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/26/2022] [Indexed: 12/13/2022]
Abstract
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.
Collapse
Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Ophthalmology and Visual Sciences, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Jeffrey Li
- Jules Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Bennie H Jeng
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Vishal Jhanji
- Eye and Ear Insitute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
10
|
Allen NE, Zhang J, McGhee CNJ. COVID-19 vaccination and corneal allograft rejection- a review. Front Cell Infect Microbiol 2023; 13:1307655. [PMID: 38162575 PMCID: PMC10757323 DOI: 10.3389/fcimb.2023.1307655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | - Charles N. J. McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
11
|
Lafay C, Assad Z, Ouldali N, Quoc EB, Clement A, Durand C, Fares S, Faye A, Eveillard LA, Kaguelidou F, Titah C, Valtuille Z, Vinit C, Meinzer U, Dumaine C. Increased Incidence of Pediatric Uveitis Associated with the COVID-19 Pandemic Occurring Before COVID-19 Vaccine Implementation: A Time-Series Analysis. J Pediatr 2023; 263:113682. [PMID: 37611738 DOI: 10.1016/j.jpeds.2023.113682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To examine whether the COVID-19 pandemic was associated with an increased incidence of uveitis in children. STUDY DESIGN We performed a time-series analysis of patient records from a national, hospital-based, French surveillance system. All children hospitalized for uveitis in France between January 2012 and March 2022 were included. The incidence of newly diagnosed uveitis per 100 000 children per trimester in France was analyzed by a quasi-Poisson regression. A cohort of children diagnosed with uveitis at Robert-Debré Hospital was used to compare the characteristics of uveitis after and before the onset of the pandemic. RESULTS During the study period, 2492 children were hospitalized for uveitis in France. The COVID-19 pandemic, which started in March 2020, was associated with a significant increase in the occurrence of uveitis (estimated cumulative change, 44.9%; 95% CI 11.4-78.4; P < .001). The increase in the incidence of pediatric uveitis started in October 2020, while the national immunization program targeting children aged less than 18 years began in June 2021. This increase involved all forms of uveitis, regardless of location, and clincial characteristics were similar to those diagnosed before the pandemic. CONCLUSIONS Our study evidenced a significant increase in the incidence of pediatric uveitis following the COVID-19 pandemic. This increase occurred 6 months before the implementation of the national COVID-19 vaccination program for children, suggesting that the resurgence of this rare disease is independent of COVID-19 vaccination.
Collapse
Affiliation(s)
- Céline Lafay
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zein Assad
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Naïm Ouldali
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Bui Quoc
- Department of Ophthalmology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ana Clement
- Department of Ophthalmology, Adolph Rothschild Hospital, Paris, France
| | - Capucine Durand
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Selim Fares
- Department of Ophthalmology, Adolph Rothschild Hospital, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurye-Anne Eveillard
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM, Centre de Recherche sur l'inflammation UMR 1149, Paris, France
| | - Florentia Kaguelidou
- Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cherif Titah
- Department of Ophthalmology, Adolph Rothschild Hospital, Paris, France
| | - Zaba Valtuille
- Center of Clinical Investigations, INSERM CIC1426, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Vinit
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ulrich Meinzer
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM, Centre de Recherche sur l'inflammation UMR 1149, Paris, France; Biology and Genetics of Bacterial Cell Wall Unit, Department of Microbiology, Institut Pasteur, Université de Paris, Paris, France.
| | - Cécile Dumaine
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM, Centre de Recherche sur l'inflammation UMR 1149, Paris, France
| |
Collapse
|
12
|
Hutchinson KA, Peretz D, Darvish M, Talajic J, Choremis J. Rare Case of Thygeson Superficial Punctate Keratitis After COVID-19 Vaccination. Cornea 2023; 42:1306-1308. [PMID: 37399572 DOI: 10.1097/ico.0000000000003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/22/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE The aim of this study was to elucidate a rare corneal association of the coronavirus disease 2019 (COVID-19) vaccine. Although cases of corneal involvement after vaccination have been reported, we present the first case of Thygeson superficial punctate keratitis (TSPK) linked to the COVID-19 vaccine. METHODS This study is a case report. RESULTS A 25-year-old woman was assessed in the ophthalmology clinic for recurrent ocular surface symptoms after receiving the COVID-19 vaccine. She was followed in clinic and was found to have a remitting and recurring pattern of bilateral intraepithelial corneal opacities with associated subepithelial haze primarily overlying the pupillary area. These corneal lesions responded well to topical corticosteroid ophthalmic drops. Based on the clinical appearance, the response to treatment, negative herpes simplex virus serology, and the temporal relationship between vaccination and ocular findings, a diagnosis of COVID-19 vaccine-induced TSPK was suspected. CONCLUSIONS Although the COVID-19 vaccine remains overwhelmingly safe, clinicians should be aware of possible corneal side effects, including TSPK. Prompt ophthalmic assessment in those presenting with ocular symptoms after vaccination is encouraged.
Collapse
Affiliation(s)
- Kelly Ann Hutchinson
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Daniel Peretz
- Faculty of Medicine and Health Sciences, Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QC, Canada; and
| | - Mahshad Darvish
- Faculty of Medicine and Health Sciences, Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QC, Canada; and
| | - Julia Talajic
- Département d'ophtalmologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Johanna Choremis
- Faculty of Medicine and Health Sciences, Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QC, Canada; and
- Département d'ophtalmologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
13
|
Ott M, Nagamany T, Zandi S, Pichi F, Agarwal A, Carreño E, Gupta V, Grewal DS, Cunningham ET, Munk MR. Herpetic anterior uveitis following COVID-19 vaccines: a case series. Front Med (Lausanne) 2023; 10:1242225. [PMID: 37809344 PMCID: PMC10556457 DOI: 10.3389/fmed.2023.1242225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose To report a case series of herpetic uveitis following COVID-19 vaccinations. Methods Demographic, clinical and treatment-related data of herpetic anterior uveitis cases was collected at five tertiary eye hospitals between January 2021 and June 2022. A retrospective database review at one of the centers comparing the number of cases of herpetic eye disease before and after the introduction of COVID-19 vaccination was performed as well. Results Twenty-four patients (9 female, 15 male) with a mean age of 54 years (range 28-83 years) were diagnosed with herpetic uveitis, reporting an onset of symptoms 3-42 days after the first, second or third dose of COVID-19 vaccination. Median time between vaccination and onset of herpetic eye disease was 10 days (mean 12.7 ± 10.15 days) days. The administered vaccines were BNT162b2, mRNA-1273, BBIBP-CorV and Ad26.COV2.S. The cases included 11 HSV, 10 VZV and 1 CMV anterior uveitis, 2 were not further specified. There was an equal number of first episodes (n = 12, 50%) and recurrent episodes (n = 12, 50%). Response to established regimens was generally good. The retrospective database review revealed the exact same incidence of herpetic uveitis during the pandemic and ongoing vaccination compared to prior SARS-CoV-2. Conclusion This report includes 24 cases of herpetic anterior uveitis in a temporal relationship to various COVID-19 vaccines. This study supports the potential risk of herpetic eye disease following COVID-19 vaccines, but proof of a direct, causal relationship is missing.
Collapse
Affiliation(s)
- Muriel Ott
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thanoosha Nagamany
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Souska Zandi
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Francesco Pichi
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Aniruddha Agarwal
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
- Department of Ophthalmology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Ester Carreño
- Department of Ophthalmology, University Hospital Fundación Jimenez Diaz, Madrid, Spain
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dilraj S. Grewal
- Department of Ophthalmology, Duke University, Durham, NC, United States
| | - Emmett T. Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, United States
- Department of Ophthalmology, School of Medicine, Stanford University, Palo Atlo, CA, United States
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, United States
| | - Marion R. Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Augenarzt-Praxisgemeinschaft Gutblick AG, Pfäffikon, Switzerland
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| |
Collapse
|
14
|
Paez-Escamilla M, Caplash S, Kalra G, Odden J, Price D, Marroquin OC, Koscumb S, Commiskey P, Indermill C, Finkelstein J, Gushchin AG, Coca A, Friberg TR, Eller AW, Gallagher DS, Harwick JC, Waxman EL, Chhablani J, Bonhomme G, Prensky C, Anetakis AJ, Martel JN, Massicotte E, Ores R, Girmens JF, Pearce TM, Sahel JA, Dansingani K, Westcott M, Errera MH. Challenges in posterior uveitis-tips and tricks for the retina specialist. J Ophthalmic Inflamm Infect 2023; 13:35. [PMID: 37589912 PMCID: PMC10435440 DOI: 10.1186/s12348-023-00342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/07/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty. METHODS An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes. RESULTS We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs). CONCLUSION This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.
Collapse
Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gagan Kalra
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamie Odden
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Danielle Price
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Stephen Koscumb
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Commiskey
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jerome Finkelstein
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anna G Gushchin
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andreea Coca
- Department of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas R Friberg
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jean C Harwick
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evan L Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gabrielle Bonhomme
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Colin Prensky
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alexander J Anetakis
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erika Massicotte
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raphaelle Ores
- Department of Ophthalmology, McGill University Campus Outaouais, Gatineau, QC, Canada
| | | | - Thomas M Pearce
- Division of Neuropathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kunal Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark Westcott
- Department of Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- UPMC Eye Center, University of Pittsburgh School of Medicine, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
15
|
Singh RB, Parmar UPS, Gupta R, Garcia AJV, Cho W, Singh KP, Agarwal A. Retinal vascular occlusion following SARS-CoV-2 vaccination: A VAERS database analysis. OPHTHALMOLOGY SCIENCE 2023; 4:100354. [PMID: 37362418 PMCID: PMC10281033 DOI: 10.1016/j.xops.2023.100354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
Purpose To evaluate the cases of retinal vessel occlusion following COVID-19 vaccination and evaluate the onset interval and clinical presentations in patients diagnosed with vaccine associated retinal artery occlusion (RAO) and retinal vein occlusion (RVO). Design Retrospective study of the cases reported to the Centers for Disease Control and Prevention (CDC) Vaccine Adverse Events Reporting System (VAERS) between December 11, 2020 and July 1, 2022. Participants Patients diagnosed with retinal vessel occlusion following vaccination with BNT162b2, mRNA-1273, and Ad26.COV2.S globally. Methods We performed a descriptive analysis of the patient demographics and clinical presentation in patients with retinal vessel occlusion. The correlation between the vaccines and continuous and categorical variables were assessed. We performed the post-hoc analysis to evaluated the association between RAO and RVO onset post-vaccination, and vaccine and dosage. Finally, a 30-day reverse analysis for RAO and RVO onset following administration of vaccine. A major limitation in the methods of this study is the lack of control group for assessing the risk of retinal vessel occlusive disease in patients who received the vaccine compared to the patients who were unvaccinated. Main Outcome Measures The crude reporting rate of retinal vessel occlusion following SARS-CoV-2 vaccine. The ocular and systemic presentations, onset duration and short term risk of RAO and RVO following vaccination. Results During the study period, 1351 retinal vessel occlusion cases were reported globally. The crude reporting rates of retinal vessel occlusion for BNT162b2, mRNA-1273, and Ad26.COV2.S were 0.36, 0.41, and 0.69, respectively. The majority of the retinal vessel occlusion cases were reported following BNT162b2 (n=606, 74.17%). The mean age of patients with RVO and RAO was 58.54 ± 16.06 years and 64.63 ± 16.16 years, respectively. In the cohort, 817 and 433 patients were diagnosed with RVO and RAO, respectively. Most cases of RVO (41.12%) and RAO (48.27%) were reported within the first week post-vaccination. We observed that the mean onset interval for RVO was significantly longer in patients who received Ad26.Cov2.S (54.07 ± 88.98 days) compared to BNT162b2 (18.07 ± 28.66 days) and mRNA-1273 (22.85 ± 38.13 days) vaccines (p<0.0001). This was further confirmed by post-hoc analysis, which revealed a significantly longer onset duration for the Ad26.Cov2.S compared to BNT162b2 and mRNA 1273 vaccines (p<0.0001). The reverse Kaplan Meier 30-day risk analysis showed a significant a higher risk of RVO onset following BNT162b2 compared to other vaccines(p<0.0001). Conclusions The low crude reporting rate highlights a low safety concern for retinal vessel occlusion following SARS-CoV-2 vaccination. This study provides insights into possible temporal association between reported retinal vessel occlusion events with SARS-CoV-2 vaccines, however further insights are needed to understand the underlying immunopathological mechanisms that promote thrombosis of retinal vasculature on vaccine administration.
Collapse
Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
- Discipline of Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Australia
| | | | - Rudraksh Gupta
- Discipline of Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Australia
| | - Antonio Jacobo Vega Garcia
- Discipline of Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Australia
| | - Wonkyung Cho
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | | | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
- Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, the Netherlands
| |
Collapse
|
16
|
Singh RB, Parmar UPS, Ichhpujani P, Jeng BH, Jhanji V. Herpetic Eye Disease After SARS-CoV-2 Vaccination: A CDC-VAERS Database Analysis. Cornea 2023; 42:731-738. [PMID: 36706232 DOI: 10.1097/ico.0000000000003246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/26/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE The aim of this study was to evaluate the cases of herpes simplex and zoster ophthalmicus after SARS-CoV-2 vaccination and assess the clinical presentations in patients. METHODS A retrospective analysis of cases reported to the Centers for Disease Control and Prevention (CDC) Vaccine Adverse Event Reporting System (VAERS) between December 11, 2020, and July 1, 2022. Patients diagnosed with herpes simplex ophthalmicus (HSO) and herpes zoster ophthalmicus (HZO) after vaccination with BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna), and Ad26.COV2.S (Janssen) were included in the study. We performed a descriptive analysis of patient demographics, history, and ophthalmic and systemic clinical presentations. The correlations between vaccine type and continuous variables were assessed by the one-way analysis of variance test. In addition, we used the Pearson χ 2 test to assess the association between 3 vaccines and categorical variables. A post hoc analysis was performed between HSO and HZO onset intervals after vaccination, dose, and vaccine type. The 30-day risk analysis was also performed for HSO and HZO onset postvaccination using the reverse Kaplan-Meier analysis. RESULTS A total of 1180 cases of HZO (983, 83.30%) and HSO (180, 15.25%) were reported. The mean age of patients with HZO and HSO was 59.02 ± 19.05 and 52.68 ± 17.83 years, respectively. Most of the cases of HZO (795, 80.87%) and HSO (131, 72.78%) were reported in patients who received BNT162b2. In the cohort, 63.28% and 65.56% diagnosed with HZO and HSO were women. About one third of HZO (36.52%) and HSO (35.56%) cases were reported after the first dose. More than half of the cases of HZO (61.34%) and HSO (64.45%) were reported within the first 2 weeks after vaccination. The estimated crude reporting rate (per million doses) in the United States was 0.25, 0.22, and 0.47 for BNT162b2, mRNA-1273, and Ad26.COV2.S, respectively. The onset interval for HZO was significantly shorter in patients who received BNT162b2 (20.51 ± 56.20 days, P = 0.030) compared with patients who received mRNA-1273 (36.56 ± 108.67 days) and Ad26.COV2.S (39.66 ± 60.15 days) vaccines. The 30-day risk analysis showed a significantly higher risk of HZO after BNT162b2 than the other 2 vaccines ( P = 0.011). CONCLUSIONS The low crude reporting rate suggests that HZO and HSO after SARS-CoV-2 vaccination occur rarely. This study provides insights into the possible temporal association between reported HSO and HZO after SARS-CoV-2 vaccines; however, further investigations are required to delineate the possible underlying immunological mechanisms.
Collapse
Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
- Discipline of Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Australia
| | | | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Bennie H Jeng
- Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA
| |
Collapse
|
17
|
Singh RB, Parmar UPS, Kahale F, Agarwal A, Tsui E. Vaccine-Associated Uveitis after COVID-19 Vaccination: Vaccine Adverse Event Reporting System Database Analysis. Ophthalmology 2023; 130:179-186. [PMID: 36055601 PMCID: PMC9428109 DOI: 10.1016/j.ophtha.2022.08.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To assess the risk of vaccine-associated uveitis (VAU) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and evaluate uveitis onset interval and clinical presentations in the patients. DESIGN A retrospective study from December 11, 2020, to May 9, 2022, using the Centers for Disease Control and Prevention Vaccine Adverse Event Reporting System. PARTICIPANTS Patients diagnosed with VAU after administration of BNT162b2 (Pfizer-BioNTech, Pfizer Inc/BioNTech SE), mRNA-1273 (Moderna, Moderna Therapeutics Inc), and Ad26.COV2.S (Janssen, Janssen Pharmaceuticals) vaccine worldwide. METHODS A descriptive analysis of the demographics, clinical history, and presentation was performed. We evaluated the correlation among the 3 vaccines and continuous and categorical variables. A post hoc analysis was performed between uveitis onset interval after vaccination and age, dose, and vaccine type. Finally, a 30-day risk analysis for VAU onset postvaccination was performed. MAIN OUTCOME MEASURES The estimated global crude reporting rate, observed to expected ratio of VAU in the United States, associated ocular and systemic presentations, and onset duration. RESULTS A total of 1094 cases of VAU were reported from 40 countries with an estimated crude reporting rate (per million doses) of 0.57, 0.44, and 0.35 for BNT162b2, mRNA-1273, and Ad26.COV2.S, respectively. The observed to expected ratio of VAU was comparable for BNT162b2 (0.023), mRNA-1273 (0.025), and Ad26.COV2.S (0.027). Most cases of VAU were reported in patients who received BNT162b2 (n = 853, 77.97%). The mean age of patients with VAU was 46.24 ± 16.93 years, and 68.65% (n = 751) were women. Most cases were reported after the first dose (n = 452, 41.32%) and within the first week (n = 591, 54.02%) of the vaccination. The onset interval for VAU was significantly longer in patients who received mRNA-1273 (21.22 ± 42.74 days) compared with BNT162b2 (11.42 ± 23.16 days) and rAd26.COV2.S (12.69 ± 16.02 days) vaccines (P < 0.0001). The post hoc analysis revealed a significantly shorter interval of onset for the BNT162b2 compared with the mRNA 1273 vaccine (P < 0.0001). The 30-day risk analysis showed a significant difference among the 3 vaccines (P < 0.0001). CONCLUSIONS The low crude reporting rate and observed to expected ratio suggest a low safety concern for VAU. This study provides insights into a possible temporal association between reported VAU events and SARS-CoV-2 vaccines; however, further investigations are required to delineate the associated immunological mechanisms.
Collapse
Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands,Discipline of Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Francesca Kahale
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates,Department of Ophthalmology, University of Maastricht, Maastricht, the Netherlands,Aniruddha Agarwal, MD, Associate Professor of Ophthalmology, Eye Institute, Cleveland Clinic Abu Dhabi, Jazeerat Al-Maryah, Abu Dhabi, UAE
| | - Edmund Tsui
- Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California,Correspondence: Edmund Tsui, MD, Assistant Professor of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095
| |
Collapse
|
18
|
Kuziez L, Eleiwa TK, Chauhan MZ, Sallam AB, Elhusseiny AM, Saeed HN. Corneal Adverse Events Associated with SARS-CoV-2/COVID-19 Vaccination: A Systematic Review. Vaccines (Basel) 2023; 11:vaccines11010166. [PMID: 36680010 PMCID: PMC9860789 DOI: 10.3390/vaccines11010166] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Lana Kuziez
- Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - Taher K. Eleiwa
- Department of Ophthalmology, Benha University, Benha 13518, Egypt
| | - Muhammad Z. Chauhan
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Ahmed B. Sallam
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Abdelrahman M. Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Correspondence: (A.M.E.); (H.N.S.)
| | - Hajirah N. Saeed
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL 60661, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
- Department of Ophthalmology, Loyola University Medical Center, Maywood, IL 60611, USA
- Correspondence: (A.M.E.); (H.N.S.)
| |
Collapse
|
19
|
Moon Y, Jung JH, Shin HJ, Choi DG, Park KA, Jeon H, Lee BJ, Kim SJ, Oh SY, Ahn H, Chung SA, Kim US, Lee HJ, Lee JY, Choi YJ. Non-Arteritic Ischemic Optic Neuropathy Following COVID-19 Vaccination in Korea: A Case Series. J Korean Med Sci 2023; 38:e95. [PMID: 36974402 PMCID: PMC10042731 DOI: 10.3346/jkms.2023.38.e95] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/27/2022] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND To report the clinical manifestations of non-arteritic anterior ischemic optic neuropathy (NAION) cases after coronavirus disease 2019 (COVID-19) vaccination in Korea. METHODS This multicenter retrospective study included patients diagnosed with NAION within 42 days of COVID-19 vaccination. We collected data on vaccinations, demographic features, presence of vascular risk factors, ocular findings, and visual outcomes of patients with NAION. RESULTS The study included 16 eyes of 14 patients (6 men, 8 women) with a mean age of 63.5 ± 9.1 (range, 43-77) years. The most common underlying disease was hypertension, accounting for 28.6% of patients with NAION. Seven patients (50.0%) had no vascular risk factors for NAION. The mean time from vaccination to onset was 13.8 ± 14.2 (range, 1-41) days. All 16 eyes had disc swelling at initial presentation, and 3 of them (18.8%) had peripapillary intraretinal and/or subretinal fluid with severe disc swelling. Peripapillary hemorrhage was found in 50% of the patients, and one (6.3%) patient had peripapillary cotton-wool spots. In eight fellow eyes for which we were able to review the fundus photographs, the horizontal cup/disc ratio was less than 0.25 in four eyes (50.0%). The mean visual acuity was logMAR 0.6 ± 0.7 at the initial presentation and logMAR 0.7 ± 0.8 at the final visit. CONCLUSION Only 64% of patients with NAION after COVID-19 vaccination have known vascular and ocular risk factors relevant to ischemic optic neuropathy. This suggests that COVID-19 vaccination may increase the risk of NAION. However, overall clinical features and visual outcomes of the NAION patients after COVID-19 vaccination were similar to those of typical NAION.
Collapse
Affiliation(s)
- Yeji Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jin Shin
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeshin Jeon
- Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyosook Ahn
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Ah Chung
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Ungsoo Samuel Kim
- Department of Ophthalmology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University College of Medicine, Jeonju, Korea
| | - Joo Yeon Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Youn Joo Choi
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | | |
Collapse
|
20
|
Yasaka Y, Hasegawa E, Keino H, Usui Y, Maruyama K, Yamamoto Y, Kaburaki T, Iwata D, Takeuchi M, Kusuhara S, Takase H, Nagata K, Yanai R, Kaneko Y, Iwahashi C, Fukushima A, Ohguro N, Sonoda KH. A multicenter study of ocular inflammation after COVID-19 vaccination. Jpn J Ophthalmol 2023; 67:14-21. [PMID: 36417027 PMCID: PMC9684958 DOI: 10.1007/s10384-022-00962-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To report the characteristics of a case series of ocular inflammatory events following COVID-19 vaccination in Japan. STUDY DESIGN Retrospective multicenter study METHODS: In this retrospective multicenter survey, a questionnaire was sent to 16 Japanese hospitals that had uveitis specialty clinics. Information on patients who developed ocular inflammatory events within 14 days of COVID-19 vaccination between February 2021 and December 2021 was collected. RESULTS Thirty-seven patients were diagnosed with ocular inflammatory events following COVID-19 vaccination. The mean age was 53.4 ± 16.4 years (range, 26-86 years), and the mean time to onset after vaccination was 6.3 ± 4.2 days (range, 1-14 days). Vogt-Koyanagi-Harada disease (VKH) was the most common event (n = 17 patients, 46%), followed by anterior uveitis (n = 6), infectious uveitis (n = 3), acute zonal occult outer retinopathy (AZOOR) (n = 2), sarcoidosis-associated uveitis (n = 1), acute posterior multifocal placoid pigment epitheliopathy (APMPPE) (n = 1), optic neuritis (n = 1), multiple evanescent white dot syndrome (MEWDS) (n = 1), Posner-Schlossman syndrome (n = 1), and unclassified uveitis (n = 4). Twenty-eight cases occurred after BNT162b2 vaccination (Pfizer-BioNTech) and 8 after mRNA-1273 vaccination (Moderna), whilst 1 patient had no information about vaccine type. CONCLUSIONS COVID-19 vaccination can be related to various types of ocular inflammatory events. When we encounter patients with ocular inflammatory disease, we should consider that it may be an adverse effect of COVID-19 vaccination.
Collapse
Affiliation(s)
- Yuta Yasaka
- grid.177174.30000 0001 2242 4849Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Eiichi Hasegawa
- grid.177174.30000 0001 2242 4849Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Hiroshi Keino
- grid.411205.30000 0000 9340 2869Department of Ophthalmology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Yoshihiko Usui
- grid.412781.90000 0004 1775 2495Department of Ophthalmology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kazuichi Maruyama
- grid.136593.b0000 0004 0373 3971Department of Vision Informatics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuki Yamamoto
- grid.272264.70000 0000 9142 153XDepartment of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Toshikatsu Kaburaki
- grid.415020.20000 0004 0467 0255Department of Ophthalmology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Daiju Iwata
- grid.39158.360000 0001 2173 7691Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Takeuchi
- grid.416614.00000 0004 0374 0880Department of Ophthalmology, National Defense Medical College, Saitama, Japan
| | - Sentaro Kusuhara
- grid.31432.370000 0001 1092 3077Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Takase
- grid.265073.50000 0001 1014 9130Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenji Nagata
- grid.272458.e0000 0001 0667 4960Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryoji Yanai
- grid.413010.7Department of Ophthalmology, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Yutaka Kaneko
- grid.268394.20000 0001 0674 7277Department of Ophthalmology and Visual Sciences, Facultyof Medicine, Yamagata University, Yamagata, Japan
| | - Chiharu Iwahashi
- grid.258622.90000 0004 1936 9967Department of Ophthalmology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Atsuki Fukushima
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Nobuyuki Ohguro
- grid.460257.20000 0004 1773 9901Department of Ophthalmology, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Koh-Hei Sonoda
- grid.177174.30000 0001 2242 4849Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | | |
Collapse
|
21
|
Loskutov IA, Korsakova NV, Lyakhova EA, Poromov AA, Pshenichnaya NY, Maleev VV. [Ophthalmic manifestations of COVID-19]. Vestn Oftalmol 2023; 139:81-88. [PMID: 37942601 DOI: 10.17116/oftalma202313905181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
In March 2020 the World Health Organization (WHO) declared a pandemic of the novel coronavirus infection (COVID-19) caused by the SARS-CoV-2 respiratory virus. The high spread rate of the virus and the severity of the course of the disease are of great clinical and epidemiological significance, making it relevant for ophthalmologists to study the mechanisms of how SARS-CoV-2 infects ocular structures, as well as possible clinical manifestations of the infection in the organ of vision. This review contains analysis, systematization, and generalization of epidemiological and clinical data on SARS-CoV-2 ocular lesions and was carried out with the data found in scientific abstract databases. The article presents main clinical ophthalmic manifestations of COVID-19, lists the utilized schemes of etiotropic and symptomatic therapy, recommended preventive measures, and considers the possible ophthalmic complications after vaccination against COVID-19.
Collapse
Affiliation(s)
- I A Loskutov
- Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - N V Korsakova
- Chuvash State University named after I.N. Ulyanov, Cheboksary, Russia
- Cheboksary branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Cheboksary, Russia
| | | | - A A Poromov
- I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - N Yu Pshenichnaya
- Central Research Institute of Epidemiology, Moscow, Russia
- National Medical Research Center for Phthisiopulmonology and Infectious Diseases, Moscow, Russia
| | - V V Maleev
- Central Research Institute of Epidemiology, Moscow, Russia
| |
Collapse
|
22
|
Veenis A, Haghnegahdar M, Ajlan R. Unilateral Episcleritis Following COVID-19 Booster Vaccination of a Crohn's Disease Patient: A Case Report and Review of the Literature. Int Med Case Rep J 2023; 16:91-96. [PMID: 36875803 PMCID: PMC9977905 DOI: 10.2147/imcrj.s398502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/28/2022] [Indexed: 02/26/2023] Open
Abstract
Purpose The Coronavirus Disease 2019 (COVID-19) pandemic spurred vaccine development and resulted in the development of the novel mRNA COVID-19 vaccine and with it, a growing public concern of vaccine side effects. There are reports of ocular inflammatory processes such as episcleritis being possible side effects of COVID-19 vaccination. Here we reported the first case of unilateral episcleritis in a Crohn's disease patient following her third mRNA COVID-19 vaccination booster shot. Patient and Methods A 27-year-old female presented with a 1-day history of right eye redness, itching, and burning. Patient reported developing these symptoms within 3-4 hours after vaccination. Her past medical history was relevant for Crohn's disease. Ophthalmic examination revealed right 2+ conjunctival injection that blanched with phenylephrine drops. Otherwise, her ophthalmic exam was unremarkable. The patient was started on artificial tears and ibuprofen 200 mg three times daily for one week. After one week all symptoms resolved, and ophthalmic examination was back to baseline. Conclusion This is the first case in the literature of ophthalmic side effects in a Crohn's disease patient after the third mRNA COVID-19 booster. Patients with Crohn's disease may respond differently to booster vaccination. This case report may help healthcare providers when counselling Crohn's disease patients about future COVID-19 mRNA vaccine side effects.
Collapse
Affiliation(s)
- Aaron Veenis
- Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Megan Haghnegahdar
- Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Radwan Ajlan
- Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, KS, USA
| |
Collapse
|
23
|
Jordan CA, Townend S, Allen N, Sims J, McGhee CN, Niederer RL. Navigating Coronavirus Disease 2019 Vaccination and Uveitis: Identifying the Rates and Risk of Recurrent Uveitis after Coronavirus Disease Vaccination. Ophthalmology 2022; 130:501-508. [PMID: 36538991 PMCID: PMC9758064 DOI: 10.1016/j.ophtha.2022.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/23/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To identify rates of uveitis reactivation both before and after the coronavirus disease (COVID) 2019 vaccine in subjects with a previous diagnosis of uveitis. DESIGN Retrospective study. PARTICIPANTS Subjects were identified from the Inflammatory Eye Disease Registry at Auckland District Health Board diagnosed with uveitis between January 1, 2010, and December 31, 2020. METHODS Date of COVID vaccination was determined from the patient clinical record. Rate of flare was calculated for 3 months before vaccination and 3 months after each vaccination. MAIN OUTCOME MEASURE Uveitis flare was defined as the presence of new uveitis activity or increased activity that required a change in uveitis treatment. RESULTS A total of 4184 eyes of 3008 patients were included in the study with a total of 8474 vaccinations given during the study period. Median age was 54.8 years, and 1474 (49.0%) were female. Noninfectious etiology was most common, occurring in 2296 patients (76.3%) and infectious etiology occurring in 712 patients (23.7%). Rate of uveitis flare was 12.3 per 1000 patient-months at baseline, 20.7 after the first dose, 15.0 after the second dose, 12.8 after the third dose, and 23.9 after the fourth dose. The median period of quiescence before flare was 3.9 years. An increase in uveitis flare was seen in both infectious uveitis (baseline 13.1 compared with 20.2 after first dose, 154% increase) and noninfectious uveitis (baseline 12.4 compared with 20.9 after first dose, 169% increase). Risk factors for uveitis flare were identified to be recurrent uveitis, chronic uveitis, shorter period of quiescence, and first dose of vaccine. Median time to uveitis flare was 0.53 months after the first vaccination, 1.74 months after the second vaccination, and 1.35 months after the third vaccination. CONCLUSIONS The current study demonstrates an increased risk of uveitis flare after the first dose of COVID vaccination. This risk was highest in those with previous recurrences, chronic uveitis, and shorter period of quiescence. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
| | - Stephanie Townend
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Natalie Allen
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Joanne Sims
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Charles N.J. McGhee
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand,Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Rachael L. Niederer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand,Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand,Correspondence: Rachael Niederer, PhD, FRANZCO, Department of Ophthalmology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| |
Collapse
|
24
|
Zhong Z, Wu Q, Lai Y, Dai L, Gao Y, Liao W, Feng X, Yang P. Risk for uveitis relapse after COVID-19 vaccination. J Autoimmun 2022; 133:102925. [PMID: 36209692 PMCID: PMC9531657 DOI: 10.1016/j.jaut.2022.102925] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/16/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Several studies suggested that coronavirus disease 2019 (COVID-19) vaccination may lead to uveitis, a vision-threatening condition often associated with a variety of autoimmune or autoinflammatory diseases. This study aims to explore factors that influence the risk of uveitis relapse after COVID-19 vaccination to guide the prevention of disease. METHODS Uveitis relapse was evidenced by worsening activity of intraocular inflammation (e.g. anterior chamber cells, vitreous haze) as defined by the Standardization of Uveitis Nomenclature Working Group. Time to uveitis relapse since the administration of each dose of COVID-19 vaccine was compared across participants with modifiable variables. RESULTS The primary analysis included 438 non-COVID-19 participants with 857 doses of COVID-19 vaccine administered in total. The median age was 41 years (interquartile range, 30 to 51), and 57.3% were female. A total of 39 episodes of uveitis relapse events occurred in 34 patients after the receipt of a dose of COVID-19 vaccine within 30 days. The median time to relapse after vaccination was 5 days (interquartile range, 1 to 14). Concomitant use of systemic glucocorticoids at the time of vaccination was independently associated with a decrease in risk of relapse after vaccination (HR, 0.23 [95% CI, 0.07-0.74]; P value = 0.014). There was a trend in attenuating the risk of relapse with increasing prednisone dose from none to less than 20 mg per day and then to 20 mg per day or greater (P value for trend = 0.029). CONCLUSIONS Concomitant treatment with systemic glucocorticoids for uveitis at the time of COVID-19 vaccination was associated with a dose-dependent lower risk of uveitis relapse after vaccination.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Peizeng Yang
- Corresponding author. The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400016, China
| |
Collapse
|
25
|
Fei P, Feng H, Li J, Liu M, Luo J, Ye H, Zhao P. Inflammatory ocular events after inactivated COVID-19 vaccination. Hum Vaccin Immunother 2022; 18:2138051. [PMID: 36369840 DOI: 10.1080/21645515.2022.2138051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To report potential vaccine-induced inflammatory ocular adverse events following inactivated COVID-19 vaccination. Retrospective study of patients with uveitis and other ocular complications following inactivated coronavirus disease 2019 (COVID-19) vaccination at a tertiary referral center between May 2021 and August 2021. Data collection consisted of demographic and clinical data. The study included 8 eyes of 5 patients (4 females, 1 male), with a mean age of 37.2 ± 12.5 years (range 28-59 years). Mean time between vaccination and ocular complications onset was 13.2 ± 11.9 days (range 3-30 days), including two patients after the first dose of the vaccine and 3 patients after the second dose. The cases reported were three anterior uveitis, one herpetic keratitis and iridocyclitis, and one posterior uveitis. Patients received treatment with local and/or systemic steroids and all the patients had good visual outcomes. Ocular inflammatory events may occur after vaccination with possible gender preponderance. However, they are rare and manageable. Overall, the efficacy and safety of vaccination should be emphasized.
Collapse
Affiliation(s)
- Ping Fei
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huazhang Feng
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jing Li
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Miaomiao Liu
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia Luo
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongfei Ye
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
26
|
Choi HG, Kim SY, Baek SU. Changes in mean and variance of ophthalmic disease incidences during COVID-19 pandemic in Korea. Sci Rep 2022; 12:20364. [PMID: 36437348 PMCID: PMC9701753 DOI: 10.1038/s41598-022-24975-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/23/2022] [Indexed: 11/28/2022] Open
Abstract
This study undertook to determine the changes in the numbers of outpatient visits for various ophthalmic diseases during the COVID-19 pandemic compared with before. The monthly outpatient visits for 14 common ophthalmic diseases were enumerated based on the ICD-10 codes in Korean National Health Insurance Service data. The differences in the mean outpatient visits and disease variance 'before' and 'during COVID-19' were calculated. Subsequently, subgroup analyses according to age and sex were performed. The number of outpatient visits for conjunctivitis, scleritis & episcleritis, keratitis, cataract, diabetic retinopathy, and traumatic ophthalmic disease were lower during than before COVID-19 (all P < 0.001). The lower numbers of outpatient visits for ophthalmic disorders during COVID-19 were consistent across the age and sex subgroups. All ophthalmic diseases other than endophthalmitis showed no change of variation 'during' relative to 'before' COVID-19. In conclusion, during the COVID-19 pandemic, the ophthalmic outpatient visits decreased for infectious and inflammatory diseases, screening diseases, and traumatic diseases. However, COVID-19 is not considered to have had a significant effect on variation.
Collapse
Affiliation(s)
- Hyo Geun Choi
- grid.256753.00000 0004 0470 5964Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea ,grid.488421.30000000404154154Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - So Young Kim
- grid.410886.30000 0004 0647 3511Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung Uk Baek
- grid.488421.30000000404154154Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-Ro 170Beon-Gil, Dongan-Gu, Anyang-Si, Gyeonggi-Do 14068 South Korea
| |
Collapse
|
27
|
Huang LY, Chiang CC, Li YL, Lai HY, Hsieh YC, Wu YH, Tsai YY. Corneal Complications after COVID-19 Vaccination: A Systemic Review. J Clin Med 2022; 11:jcm11226828. [PMID: 36431307 PMCID: PMC9698276 DOI: 10.3390/jcm11226828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Li-Ying Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Chun-Chi Chiang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 406040, Taiwan
- Department of Optometry, Asia University, Taichung 413305, Taiwan
| | - You-Ling Li
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Hung-Yin Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Yi-Ching Hsieh
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Ying-Hsuen Wu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 406040, Taiwan
- Department of Optometry, Asia University, Taichung 413305, Taiwan
- Correspondence: ; Tel.: +886-4-22052121 (ext. 1141); Fax: +886-4-22059265
| |
Collapse
|
28
|
Ichhpujani P, Parmar UPS, Duggal S, Kumar S. COVID-19 Vaccine-Associated Ocular Adverse Effects: An Overview. Vaccines (Basel) 2022; 10:1879. [PMID: 36366386 PMCID: PMC9697513 DOI: 10.3390/vaccines10111879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/24/2022] [Accepted: 11/01/2022] [Indexed: 07/29/2023] Open
Abstract
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.
Collapse
|
29
|
Pillar S, Weinberg T, Amer R. Posterior ocular manifestations following BNT162b2 mRNA COVID-19 vaccine: a case series. Int Ophthalmol 2022; 43:1677-1686. [PMID: 36316618 PMCID: PMC9628305 DOI: 10.1007/s10792-022-02565-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Purpose To report the occurrence of posterior ocular adverse events following the administration of the BNT162b2 mRNA vaccine against SARS-CoV-2. Methods A retrospective consecutive case series, in which the medical files of patients presenting with ocular adverse events within 30 days of the vaccine inoculation, were analyzed. Results Four patients (2 females) were included in the study. The diagnoses included: posterior scleritis, paracentral acute middle maculopathy, herpes panuveitis, and Vogt–Koyanagi–Harada (VKH)-like uveitis. Three of the patients had no relevant ocular history, but the patient who developed scleritis was in remission without medical therapy for four years, until the flare-up, which occurred one day after the vaccine. All patients improved with treatment. Conclusion Though a causal relationship cannot be definitively established, the temporal relationship suggests a possible link between the COVID-19 vaccine and the posterior ocular complications. The benefits of vaccination clearly outweigh the potential adverse effects; however, ophthalmologists should be aware of the potential for vaccine-associated uveitis.
Collapse
Affiliation(s)
- Shani Pillar
- Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, 91120, Jerusalem, Israel
| | - Tamar Weinberg
- Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, 91120, Jerusalem, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, 91120, Jerusalem, Israel.
| |
Collapse
|
30
|
Mohammadpour M, Farrokhpour H, Sadeghi R. Herpetic endotheliitis and stromal keratitis following inactivated COVID-19 vaccination. Clin Case Rep 2022; 10:e6397. [PMID: 36237947 PMCID: PMC9536498 DOI: 10.1002/ccr3.6397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/31/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
Given the scarcity of data regarding ocular complications following COVID‐19 vaccination, the approach toward patients with suggestive symptoms and established clinical practice is lacking. Herein, we report the first case of herpetic endotheliithis and secondary stromal keratitis following inactivated COVID‐19 vaccination who experienced a relapse due to poor adherence.
Collapse
Affiliation(s)
- Mehrdad Mohammadpour
- Translational Ophthalmology Research CenterFarabi Eye Hospital, Tehran University of Medical SciencesTehranIran
| | - Hossein Farrokhpour
- Translational Ophthalmology Research CenterFarabi Eye Hospital, Tehran University of Medical SciencesTehranIran
| | - Reza Sadeghi
- Translational Ophthalmology Research CenterFarabi Eye Hospital, Tehran University of Medical SciencesTehranIran
| |
Collapse
|
31
|
Osman M, Mehana O, Eissa M, Zeineldin S, Sinha A. Coronavirus Disease 2019-induced Acute Exudative Polymorphous Vitelliform Maculopathy. Middle East Afr J Ophthalmol 2022; 29:235-237. [PMID: 38162565 PMCID: PMC10754108 DOI: 10.4103/meajo.meajo_61_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 01/03/2024] Open
Abstract
Acute exudative polymorphous vitelliform maculopathy (AEPVM) is a rare entity characterized by acute multifocal macular detachment with polymorphous subretinal vitelliform deposits. The disease is a presumed retinal pigment epithelial dysfunction and is reported to occur with malignancies. We report a case of a 32-year-old otherwise healthy woman who presented with an acute bilateral visual disturbance a few days after testing positive for coronavirus disease 2019 (COVID-19). Her initial visual acuity was 6/6 in both eyes. Fundus examination revealed bilateral multifocal round yellowish subretinal deposits. Spectral-domain optical coherence tomography showed bilateral foveal serous retinal detachment with subretinal hyperreflective materials consistent with vitelliform deposits. Systemic workup to exclude malignancies and genetic diseases was unremarkable. The patient was observed without treatment, and the vitelliform materials gradually resolved over 18 months of follow-up. In our era of the global pandemic, AEPVM may be associated with COVID-19 infection.
Collapse
Affiliation(s)
- Mohamed Osman
- Department of Ophthalmology, St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Omar Mehana
- Department of Ophthalmology, St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Mahmoud Eissa
- Department of Ophthalmology, Salisbury District Hospital, Salisbury, United Kingdom
| | - Sara Zeineldin
- Medical Doctor, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Akatya Sinha
- Foundation Doctor, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| |
Collapse
|
32
|
Singh RB, Parmar UPS, Cho W, Ichhpujani P. Glaucoma Cases Following SARS-CoV-2 Vaccination: A VAERS Database Analysis. Vaccines (Basel) 2022; 10:1630. [PMID: 36298495 PMCID: PMC9610013 DOI: 10.3390/vaccines10101630] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 07/25/2023] Open
Abstract
Background: To counter the rapidly spreading severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), global vaccination efforts were initiated in December 2020. We assess the risk of glaucoma following SARS-CoV-2 vaccination and evaluate its onset interval and clinical presentations in patients. Methods: We performed a retrospective analysis of the glaucoma cases reported to the Vaccine Adverse Event Reporting System (VAERS) database between 16 December 2020, and 30 April 2022. We assessed the crude reporting rate of glaucoma, clinical presentations, onset duration, and associated risk factors. Results: During this period, 161 glaucoma cases were reported, with crude reporting rates (per million doses) of 0.09, 0.06, and 0.07 for BNT162b2, mRNA-1273, and Ad26.COV2.S, respectively. The mean age of the patients was 60.41 ± 17.56 years, and 67.7% were women. More than half (56.6%) of the cases were reported within the first week of vaccination. The cumulative-incidence analysis showed a higher risk of glaucoma in patients who received the BNT162b2 vaccines compared with mRNA-1273 (p = 0.05). Conclusions: The incidence of glaucoma following vaccination with BNT162b2, mRNA-1273, or Ad26.COV2.S is extremely rare. Amongst the patients diagnosed with glaucoma, the onset interval of adverse events was shorter among those who received the BNT162b2 and rAd26.COV2.S vaccines compared with mRNA-1273. Most glaucoma cases were reported within the first week following vaccination in female patients and from the fifth to seventh decade. This study provides insights into the possible temporal association between reported glaucoma events and SARS-CoV-2 vaccines; however, further investigations are required to identify the potential causality link and pathological mechanisms.
Collapse
Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
- Department of Ophthalmology, Leiden University Medical Center, 2333 Leiden, The Netherlands
- Discipline of Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide 5000, Australia
| | - Uday Pratap Singh Parmar
- Glaucoma Service, Department of Ophthalmology, Government Medical College and Hospital, Chandigarh 160019, India
| | - Wonkyung Cho
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
| | - Parul Ichhpujani
- Glaucoma Service, Department of Ophthalmology, Government Medical College and Hospital, Chandigarh 160019, India
| |
Collapse
|
33
|
Bhatti MT, Gilbert AL, Watson G, Waheed M, Spencer D. Shot in the Dark. Surv Ophthalmol 2022:S0039-6257(22)00123-0. [PMID: 36150481 PMCID: PMC9489960 DOI: 10.1016/j.survophthal.2022.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 11/24/2022]
Abstract
A 43-year-old woman presented with decreased vision in the right eye associated with painful eye movements 10 days after receiving her first dose of Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine (Pfizer Inc, New York, NY). Two days later she developed painful loss of vision in the left eye. Clinical presentation and magnetic resonance imaging findings were consistent with bilateral optic perineuritis transitioning to optic neuritis. Extensive evaluation including aquaporin-4 immunoglobin G (IgG), myelin oligodendrocyte glycoprotein IgG, and lumbar puncture was unrevealing. Visual acuity at nadir was counting fingers in both eyes, but after receiving intravenous steroids and plasma exchange vision eventually improved to 20/20 in each eye, although she was left with inferior visual field defects and bilateral optic disc pallor. This case highlights the diagnostic challenge in the evaluation of atypical optic neuritis with a review of post-COVID-19 vaccination-associated optic neuritis.
Collapse
Affiliation(s)
- M Tariq Bhatti
- Department of Ophthalmology, The Permanente Medical Group, Roseville, CA.
| | - Aubrey L Gilbert
- Department of Ophthalmology, The Permanent Medical Group, Vallejo, CA
| | - George Watson
- Department of Neurology, The Permanente Medical Group, Roseville, CA
| | - Mark Waheed
- Department of Ophthalmology, The Permanent Medical Group, Vallejo, CA
| | - Doran Spencer
- Shiley Eye Institute, University of California, San Diego, La Jolla, CA
| |
Collapse
|
34
|
Moura‐Coelho N, Cunha JP, Papa‐Vettorazzi R, Gris Ó, Güell JL. Acute corneal allograft rejection following SARS-CoV-2 vaccination-A systematic review. Acta Ophthalmol 2022; 101:e1-e13. [PMID: 35781792 PMCID: PMC9349413 DOI: 10.1111/aos.15211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/23/2022] [Accepted: 06/21/2022] [Indexed: 01/26/2023]
Abstract
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.
Collapse
Affiliation(s)
- Nuno Moura‐Coelho
- Cornea and Refractive Surgery UnitInstituto Microcirurgia Ocular (IMO) BarcelonaBarcelonaSpain
- NOVA Medical SchoolFaculdade de Ciências Médicas–Universidade Nova de Lisboa (NMS|FCM‐UNL)LisbonPortugal
- European School for Advanced Studies in Ophthalmology (ESASO)LuganoSwitzerland
- OphthalmologyHospital CUF CascaisCascaisPortugal
| | - João Paulo Cunha
- OphthalmologyHospital CUF CascaisCascaisPortugal
- Escola Superior de Tecnologias da Saúde de Lisboa (ESTeSL)–Instituto Politécnico de LisboaLisbonPortugal
| | - Renato Papa‐Vettorazzi
- Cornea and Refractive Surgery UnitInstituto Microcirurgia Ocular (IMO) BarcelonaBarcelonaSpain
- Anterior Segment UnitClínica Visualiza GuatemalaCity of GuatemalaGuatemala
| | - Óscar Gris
- Cornea and Refractive Surgery UnitInstituto Microcirurgia Ocular (IMO) BarcelonaBarcelonaSpain
- Universidad Autónoma de Barcelona (UAB)BarcelonaSpain
| | - José Luis Güell
- Cornea and Refractive Surgery UnitInstituto Microcirurgia Ocular (IMO) BarcelonaBarcelonaSpain
- European School for Advanced Studies in Ophthalmology (ESASO)LuganoSwitzerland
- Universidad Autónoma de Barcelona (UAB)BarcelonaSpain
| |
Collapse
|
35
|
Non-Arteritic Anterior Ischemic Optic Neuropathy Following COVID-19 Vaccination. Vaccines (Basel) 2022; 10:vaccines10060931. [PMID: 35746538 PMCID: PMC9229603 DOI: 10.3390/vaccines10060931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
People are advised to receive a vaccine booster as the Delta and Omicron variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerge, but various adverse ocular reactions after vaccination have been reported. NAION following COVID-19 vaccination appears extremely rarely. Here, we report a case of a 61-year-old female with sudden painless blurred vision developing NAION after receiving ChAdOx1 nCoV-19 (AstraZeneca) vaccination and provide an in-depth explanation of the possible mechanisms regarding the hypercoagulable state after vaccination. Our report adds to the literature on potential adverse ocular effects after COVID-19 vaccination, and we as ophthalmologists recommend that clinicians should increase awareness of this possible ocular complication when evaluating patients with sudden visual disturbance with a recent history of vaccination.
Collapse
|
36
|
Ocular Adverse Events after Inactivated COVID-19 Vaccination. Vaccines (Basel) 2022; 10:vaccines10060918. [PMID: 35746527 PMCID: PMC9230105 DOI: 10.3390/vaccines10060918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose: To report the clinical characteristics of ocular adverse events that have occurred, in China, after vaccination with inactivated COVID-19 vaccines. Methods: A retrospective cross-sectional observational study was conducted of ocular disorders that occurred within 15 days from any dose of an inactivated COVID-19 vaccine. Information on gender, age, the interval between the vaccination and ocular symptoms, laterality, duration of the ocular symptoms, primary visual acuity, and clinical diagnosis were retrospectively collected. Results: Twenty-four patients were involved in the study, including 15 females and 9 males, with a mean age of 41 ± 16 years (range of 8−71 years). The patients all denied a prior history of COVID-19 infection. Ocular adverse events occurred after the first dose of vaccine in 18 patients and, after the second or third doses, in six patients. The interval between vaccination with the inactivated COVID-19 vaccine and ocular symptoms was 6 ± 5 days; six patients were bilaterally involved and 18 patients were unilaterally involved. Regarding the diagnosis, 10 patients were diagnosed with white dot syndrome (WDS), 9 patients were diagnosed with uveitis, and 5 patients were diagnosed with retinal vascular disorders. The ages of patients with WDS were younger than those with uveitis or retinal vascular disorders (32 ± 10 vs. 48 ± 18, p < 0.05). For patients diagnosed with WDS, the best-corrected visual acuity (BCVA) was 0.74 ± 0.73 LogMAR. For patients diagnosed with retinal vascular disorders or uveitis, the BCVA was 1.44 ± 1.26 LogMAR. There was no significant difference (p > 0.05). Conclusions: A relationship cannot be established between inactivated COVID-19 vaccines and ocular disorders; therefore, further investigation of the clinical spectrum of ocular adverse events after vaccination with an inactivated COVID-19 vaccine is necessary.
Collapse
|