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Dutt DDCS, Lam J, Richards J. Bilateral Relentless Placoid Chorioretinitis Following Pfizer-BioNTech COVID-19 Vaccination: Specific Antigenic Trigger or Nonspecific Immune Activation? Ocul Immunol Inflamm 2024; 32:1498-1503. [PMID: 37552853 DOI: 10.1080/09273948.2023.2239338] [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: 04/24/2022] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE To report bilateral relentless placoid chorioretinitis following Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine administration. CASE REPORT A 55-year-old Caucasian New Zealand-born woman presented with progressive left eye vision loss and bilateral photopsias and floaters occurring 10 days after receiving the Pfizer-BioNTech COVID-19 vaccination. She had a similar self-limiting episode of photopsias and floaters without vision loss 1 year prior after receiving the influenza vaccine. Snellen visual acuity (VA) was 20/25 in the right eye, and count fingers at 2 m in the left eye. Bilateral, active, creamy, plaque-like lesions were present at the level of the retinal pigment epithelium and choroid, suggestive of relentless placoid chorioretinitis. Commencement of 100 mg oral prednisolone and 3 g mycophenolate daily resulted in recovery of the foveal ellipsoid layer with VA of 20/25 in each eye after 8 weeks. Subsequent activations occurred following COVID-19 infection and respiratory infection. CONCLUSION This is the first reported case of relentless placoid chorioretinitis occurring as a potential side-effect of the Pfizer-BioNTech COVID-19 vaccine. Vaccination, and not infection, could be assumed to be the likely trigger. Subsequent flares following COVID-19 and a nonspecific respiratory infection during periods of inadequate immunosuppression suggest that a COVID-19 antigen or general immune activation could also be the trigger.
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Cho SK, Wu XN, Amaratunge C. Acute Uveitis Following AstraZeneca COVID-19 Vaccination. Ocul Immunol Inflamm 2023; 31:1295-1298. [PMID: 37023373 DOI: 10.1080/09273948.2023.2189456] [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: 03/28/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE To report a case of bilateral acute uveitis following the first and subsequent doses of Oxford-AstraZeneca COVID-19 vaccination. METHOD A case report. RESULTS A 74-year-old Caucasian woman was presented with a one-day history of blurred vision, pain, photophobia, and redness in both eyes after receiving her first dose of the Oxford-AstraZeneca COVID-19 vaccine. Clinical evaluation confirmed bilateral anterior and intermediate uveitis six days later. Targeted diagnostic testing excluded infectious or autoimmune etiologies. After treatment with topical and oral corticosteroids, the patient had a resolution of symptoms with the recovery of visual function within seven weeks. Subsequently, she developed a recurrence of uveitis following the second dose of the Oxford-AstraZeneca COVID-19 vaccine, which required similar treatment, with slower tapering of corticosteroids over ten weeks. The patient had a full visual recovery. CONCLUSION Our case highlights the possibility of uveitis as an ocular complication of Oxford-AstraZeneca COVID-19 vaccination.
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Affiliation(s)
- Sae Kyung Cho
- Department of Ophthalmology, Fremantle Hospital, Perth, Australia
| | - Xia Ni Wu
- Department of Ophthalmology, Fremantle Hospital, Perth, Australia
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Xu K, Gao B, Li J, Xiang Y, Cao L, Zhao M. Clinical features, diagnosis, and management of COVID-19 vaccine-associated Vogt-Koyanagi-Harada disease. Hum Vaccin Immunother 2023; 19:2220630. [PMID: 37282614 PMCID: PMC10305503 DOI: 10.1080/21645515.2023.2220630] [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: 03/17/2023] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 06/08/2023] Open
Abstract
Vogt-Koyanagi-Harada (VKH) disease is a rare and serious ocular adverse reaction following COVID-19 vaccination. This study aimed to evaluate the clinical features, diagnosis and management of COVID-19 vaccine-associated VKH disease. Case reports of VKH disease after COVID-19 vaccination were collected up to February 11, 2023 for retrospective analysis. Twenty-one patients (9 males and 12 females) were included, with a median age of 45 years (range 19-78), from three main regions, Asia (12/21), the Mediterranean region (4/21), and South America (5/21). Fourteen patients developed symptoms after the first dose of the vaccine, and 8 after the second dose. Vaccines included mRNA vaccine (10 cases), virus vector vaccine (6 cases), and inactivated vaccine (5 cases). The average time interval from vaccination to onset of symptoms was 7.5 days (range 12 hours to 4 weeks). All 21 patients experienced visual impairment after vaccination, with 20 cases involving both eyes. Sixteen patients showed symptoms of meningitis. Serous retinal detachment was observed in 16 patients, choroidal thickening was observed in 14, aqueous cell in 9, and subretinal fluid in 6. CSF pleocytosis was detected in 7 patients and skin symptoms were found in 3 patients. All patients received corticosteroid therapy, and 8 also received immunosuppressive agents. All patients recovered well, with a mean recovery time of 2 months. Early diagnosis and early treatment are crucial to the prognosis of patients with VKH after vaccination with COVID-19 vaccine. The risk of vaccination against COVID-19 in patients with a history of VKH disease should be evaluated clinically.
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Affiliation(s)
- Ke Xu
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Bingqian Gao
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Jiayi Li
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yixin Xiang
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Lin Cao
- Academician Workstation, Changsha Medical University, Changsha, China
- Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, China
| | - Mingyi Zhao
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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Li S, Ho M, Mak A, Lai F, Brelen M, Chong K, Young A. Intraocular inflammation following COVID-19 vaccination: the clinical presentations. Int Ophthalmol 2023; 43:2971-2981. [PMID: 37000311 PMCID: PMC10064965 DOI: 10.1007/s10792-023-02684-4] [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: 10/04/2022] [Accepted: 03/04/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE The purpose of the study was to describe the cases of intraocular inflammation following COVID-19 vaccination (Comirnaty mRNA vaccine and CoronaVac vaccine) in Hong Kong. METHODS This was a retrospective case series. RESULTS This series includes 16 eyes among 10 female patients, with a mean age of 49.4 ± 17.4 years. Eight patients (80%) received the Pfizer-BioNTech mRNA vaccination. Anterior uveitis was the most common presentation of postvaccination uveitis (50%) observed in our series, followed by intermediate uveitis (30%) and posterior uveitis (20%), respectively. A case of retinal vasculitis in the form of frosted branch angiitis, previously only reported following COVID-19 infection, was observed following COVID-19 vaccination. The median time from vaccination to uveitis onset was 15.2 days (range: 0-6 weeks). Inflammation in 11 out 16 eyes (68.75%) was completely resolved with topical steroids. CONCLUSION Anterior uveitis was the predominant presentations of uveitis flare-ups following COVID-19 in our case series, followed by intermediate uveitis. Aligning with the current global literature concerning this issue, most of the uveitis attacks presented as anterior uveitis and were completely resolved with topical steroids. Consequently, the risk of uveitis flare-ups should not deter the public from receiving COVID-19 vaccines.
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Affiliation(s)
- Sophia Li
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital & Alice Ho Miu Ling Nethersol, Sha Tin, Hong Kong SAR, China
| | - Mary Ho
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital & Alice Ho Miu Ling Nethersol, Sha Tin, Hong Kong SAR, China.
| | - Andrew Mak
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital & Alice Ho Miu Ling Nethersol, Sha Tin, Hong Kong SAR, China
| | - Frank Lai
- Clarity Eye and Surgery Centre, Kowloon, Hong Kong SAR, China
| | - Marten Brelen
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital & Alice Ho Miu Ling Nethersol, Sha Tin, Hong Kong SAR, China
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
| | - Kelvin Chong
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital & Alice Ho Miu Ling Nethersol, Sha Tin, Hong Kong SAR, China
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
| | - Alvin Young
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital & Alice Ho Miu Ling Nethersol, Sha Tin, Hong Kong SAR, China
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
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Peyman A, Pourazizi M, Dehghani S, Ghorbani S. Recurring nodular scleritis following inactivated vaccination for COVID-19. Clin Case Rep 2023; 11:e7420. [PMID: 37323271 PMCID: PMC10264956 DOI: 10.1002/ccr3.7420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/08/2023] [Accepted: 05/08/2023] [Indexed: 06/17/2023] Open
Abstract
Key Clinical Message Though COVID-19 vaccination saved many lives all around the world, it has had many adverse effects including ophthalmologic side effects. It is important to report such adverse effects to provide timely diagnosis and management. Abstract Since the COVID-19 global outbreak, many types of vaccines have been introduced. These vaccines have been associated with some adverse effects including ocular manifestations. Herein, we report a case of a patient who developed nodular scleritis shortly after receiving the first and second doses of the inactivated COVID-19 vaccine, Sinopharm.
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Affiliation(s)
- Alireza Peyman
- Department of Ophthalmology, Isfahan Eye Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Mohsen Pourazizi
- Department of Ophthalmology, Isfahan Eye Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Shakiba Dehghani
- Department of Ophthalmology, Farabi Eye HospitalTehran University of Medical ScienceTehranIran
| | - Sarah Ghorbani
- Department of Ophthalmology, Isfahan Eye Research CenterIsfahan University of Medical SciencesIsfahanIran
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Habot-Wilner Z, Neri P, Okada AA, Agrawal R, Xin Le N, Cohen S, Fischer N, Kilmartin F, Coman A, Kilmartin D. COVID Vaccine-Associated Uveitis. Ocul Immunol Inflamm 2023:1-8. [PMID: 37145198 DOI: 10.1080/09273948.2023.2200858] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE Following the pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, different vaccines were developed and approved by the main medical authorities under emergency protocol regulations. Although highly effective and well-tolerated in most patients, vaccines can uncommonly cause ocular adverse effects. In this article, the current evidence related to vaccine-associated uveitis is reviewed. METHODS A literature review of uveitis post various SARS-CoV-2 vaccinations. RESULTS Uveitis was reported following various forms of vaccinations but was more commonly seen following the Pfizer mRNA vaccine which is the most used vaccination worldwide. In western countries, the most common uveitis is mild anterior uveitis, developing within a week of first or subsequent vaccination with good resolution following appropriate topical steroid therapy in most cases. Posterior uveitis and particularly Vogt-Koyanagi-Harada disease was more prevalent in Asia. Uveitis may develop among known uveitis patients and those with other autoimmune diseases. CONCLUSION Uveitis following Covid vaccinations is uncommon and has a good prognosis.
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Affiliation(s)
- Zohar Habot-Wilner
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Piergiorgio Neri
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Lerner College of Medicine, Case Western University, Cleveland, Ohio, USA
- College of Medicine and Health Science, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Annabelle A Okada
- Kyorin Eye Center, Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, Singapore
- Lee Kong Chian School of Medicine, Singapore
- Eye ACP Program, Duke NUS Medical School, Antimicrobials and Anti-infectives, Singapore Eye Research Institute, Singapore
| | - Ng Xin Le
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Shai Cohen
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Fischer
- Department of Ophthalmology, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Amy Coman
- University College Dublin Medical School, Dublin, Ireland
- Department of Ophthalmology, Royal Victoria Eye & Ear Hospital, Dublin, Ireland
| | - Dara Kilmartin
- University College Dublin Medical School, Dublin, Ireland
- Department of Ophthalmology, Royal Victoria Eye & Ear Hospital, Dublin, Ireland
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Choroidal and Retinal Vascular Findings in Patients with COVID-19 Complicated with Pneumonia: Widefield Imaging. Diagnostics (Basel) 2023; 13:diagnostics13061114. [PMID: 36980424 PMCID: PMC10047816 DOI: 10.3390/diagnostics13061114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Purpose: The purpose of this study was to analyze choroidal and retinal vascular alterations of both the macula and midperiphery areas in patients hospitalized for COVID-19 infection complicated with pneumonia within 30 days from discharge. Methods: A total of 46 eyes of 23 subjects with a history of symptomatic COVID-19 infection and recent hospitalization for pneumonia were enrolled in this observational study. Patients had not been previously vaccinated against COVID-19. A group of patients homogenous for age and sex was enrolled as controls. Microvascular retinal and choroidal features of the enrolled patients were studied with widefield optical coherence tomography angiography (OCT-A). Perfusion parameters in terms of the vessel density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) and the choroidal vascularity index (CVI) on enhanced depth imaging (EDI) mode OCT scans were analyzed. Results: Our cohort of patients showed a trend of reduction in VD, significantly in the SCP VD of the superior and inferior midperiphery sectors, whereas the CVI did not show significant differences between the cases and controls. Moreover, a positive correlation between CVI and vessel density in the deep capillary plexus in the macular area (VD-DCP-MAC) was found. Conclusion: The systemic disease due to COVID-19 can also involve the retina and choroid with multiple mechanisms: ischemic and inflammatory. Our study showed changes in perfusion occurring in the eyes of patients with a recent hospitalization for COVID-19 complicated with pneumonia and without any possible ocular effect due to the vaccines. There is still the need to better comprise how long COVID-19 actually affects vascular changes in the eye.
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Hashimoto Y, Yamana H, Iwagami M, Ono S, Takeuchi Y, Michihata N, Uemura K, Yasunaga H, Aihara M, Kaburaki T. Ocular Adverse Events after Coronavirus Disease 2019 mRNA Vaccination: Matched Cohort and Self-Controlled Case Series Studies Using a Large Database. Ophthalmology 2023; 130:256-264. [PMID: 36306975 PMCID: PMC9597516 DOI: 10.1016/j.ophtha.2022.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate the risk of ocular adverse events after Coronavirus Disease 2019 (COVID-19) mRNA vaccination. DESIGN Matched cohort and self-controlled case series (SCCS) studies. PARTICIPANTS We used a population-based database of medical claims and vaccination records in a large Japanese city. In the matched cohort study, we identified individuals who received COVID-19 vaccination (BNT162b2) from February 2021 to September 2021. One control was selected from nonvaccinated individuals by matching time, date of birth, sex, Charlson comorbidity index, and the enrollment period for health insurance. In the SCCS study, we analyzed individuals who developed ocular adverse events. METHODS In the matched cohort study, we applied the Kaplan-Meier estimator to estimate the cumulative incidence of ocular adverse events over 21 days after the first dose and 84 days after the second dose. In the SCCS method, we used conditional Poisson regression to estimate the incidence rate ratio (IRR) of ocular adverse events during the risk periods (0-21 days after the first dose and 0-84 days after the second dose) compared with the remaining periods. MAIN OUTCOME MEASURES Composite outcome of uveitis, scleritis, retinal vein occlusion (RVO), and optic neuritis. RESULTS There were 99 718 pairs eligible for the matched cohort study after the first dose (mean age, 69.3 years; male, 44%). The vaccinated and control groups developed 29 and 21 events, respectively, over 21 days after the first dose, and 79 and 28 events, respectively, over 84 days after the second dose. The differences in cumulative incidence (reference, the control group) were 2.9 (95% confidence interval, -14.5 to 19.1) events/100 000 persons and 51.3 (16.2-84.3) events/100 000 persons, respectively, for the first and second doses. The SCCS study showed the IRRs of 0.89 (0.62-1.28) and 0.89 (0.71-1.11) for the first and second doses, respectively. CONCLUSIONS The matched cohort analysis found an increased risk for the composite outcome after the second dose; however, the SCCS analysis showed no increased risk. Considering that the SCCS can cancel out time-invariant confounders, the current results suggest that COVID-19 vaccination is unlikely to causally increase the risk of ocular adverse events. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Yohei Hashimoto
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshinori Takeuchi
- Division of Medical Statistics, Department of Social Medicine, Faculty of Medicine, Toho University, Tokyo, Japan,Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kohei Uemura
- Department of Biostatistics and Bioinformatics, Interfaculty Initiative in Information Studies, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Hromić-Jahjefendić A, Barh D, Uversky V, Aljabali AA, Tambuwala MM, Alzahrani KJ, Alzahrani FM, Alshammeri S, Lundstrom K. Can COVID-19 Vaccines Induce Premature Non-Communicable Diseases: Where Are We Heading to? Vaccines (Basel) 2023; 11:vaccines11020208. [PMID: 36851087 PMCID: PMC9960675 DOI: 10.3390/vaccines11020208] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
According to the WHO, as of January 2023, more than 850 million cases and over 6.6 million deaths from COVID-19 have been reported worldwide. Currently, the death rate has been reduced due to the decreased pathogenicity of new SARS-CoV-2 variants, but the major factor in the reduced death rates is the administration of more than 12.8 billion vaccine doses globally. While the COVID-19 vaccines are saving lives, serious side effects have been reported after vaccinations for several premature non-communicable diseases (NCDs). However, the reported adverse events are low in number. The scientific community must investigate the entire spectrum of COVID-19-vaccine-induced complications so that necessary safety measures can be taken, and current vaccines can be re-engineered to avoid or minimize their side effects. We describe in depth severe adverse events for premature metabolic, mental, and neurological disorders; cardiovascular, renal, and autoimmune diseases, and reproductive health issues detected after COVID-19 vaccinations and whether these are causal or incidental. In any case, it has become clear that the benefits of vaccinations outweigh the risks by a large margin. However, pre-existing conditions in vaccinated individuals need to be taken into account in the prevention and treatment of adverse events.
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Affiliation(s)
- Altijana Hromić-Jahjefendić
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, International University of Sarajevo, Hrasnicka Cesta 15, 71000 Sarajevo, Bosnia and Herzegovina
| | - Debmalya Barh
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur 721172, India
- Correspondence: (D.B.); (K.L.)
| | - Vladimir Uversky
- Department of Molecular Medicine and USF Health Byrd Alzheimer's Institute, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Alaa A. Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, P.O. Box 566, Irbid 21163, Jordan
| | - Murtaza M. Tambuwala
- Lincoln Medical School, Brayford Pool Campus, University of Lincoln, Lincoln LN6 7TS, UK
| | - Khalid J. Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Fuad M. Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Saleh Alshammeri
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia
| | - Kenneth Lundstrom
- PanTherapeutics, Route de Lavaux 49, CH1095 Lutry, Switzerland
- Correspondence: (D.B.); (K.L.)
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Sheng Q, Sun Y, Zhai R, Fan X, Ying Y, Kong X. Posner-Schlossman syndrome relapse following inactivated COVID-19 vaccination in China. Front Public Health 2023; 10:1051378. [PMID: 36711335 PMCID: PMC9880426 DOI: 10.3389/fpubh.2022.1051378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction This retrospective study aims to present the characteristics of Posner-Schlossman syndrome (PSS) relapse following inactivated COVID-19 vaccination. Methods From 2020 to 2022, 12 out of 106 PSS patients undergoing relapses after any dose of inactivated COVID-19 vaccines were enrolled. Medical histories, information on the vaccination and systemic adverse events were collected. Patients were treated with corticosteroids, intraocular pressure (IOP)-lowering drugs and systemic immunosuppressive agents (if needed). Daily regimen and release course were noted. Results The recurrence rate after vaccination was 11.32% (12/106, 95% CI: 5.29%-17.35%) among 106 PSS patients we surveyed. All the 12 patients were inoculated with inactivated COVID-19 vaccines developed by Sinopharm, China. The mean time of relapse was 5.27 ± 3.72 days (range: 1-13 days, median: 4 days). Higher IOP and more keratic precipitates (KPs) were seen in the relapse following vaccination (33.55 ± 12.99 mmHg, 91.67% had KPs compared to 25.38 ± 3.80 mmHg, 33.33% had KPs in previous relapse, P = 0.009). The mean release course was 30.71 ± 34.74 days for the relapse following vaccination and 7.33 ± 6.51 days for previous relapses. The attack frequency before and after vaccination was 3.56 ± 2.07 and 9.11 ± 7.34 times per year (P = 0.044). Higher daily doses of corticosteroids, IOP-lowering drugs and ganciclovir were needed to maintain stable course, though the difference did not reach statistical significance. Discussion More frequent relapses and harder control of IOP were found in PSS relapse following COVID-19 vaccination. Ophthalmologists need to be aware of the group vulnerability and take precautions, though the pathogenesis is still under investigation.
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Affiliation(s)
- Qilian Sheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China,National Health Commission Key Laboratory of Myopia (Fudan University), Shanghai, China,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yanan Sun
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China,National Health Commission Key Laboratory of Myopia (Fudan University), Shanghai, China,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Ruyi Zhai
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China,National Health Commission Key Laboratory of Myopia (Fudan University), Shanghai, China,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xintong Fan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China,National Health Commission Key Laboratory of Myopia (Fudan University), Shanghai, China,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yue Ying
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China,National Health Commission Key Laboratory of Myopia (Fudan University), Shanghai, China,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiangmei Kong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China,National Health Commission Key Laboratory of Myopia (Fudan University), Shanghai, China,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China,*Correspondence: Xiangmei Kong ✉
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11
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New onset of acute uveitis following COVID-19 vaccination. Graefes Arch Clin Exp Ophthalmol 2023; 261:555-560. [PMID: 35939122 PMCID: PMC9358066 DOI: 10.1007/s00417-022-05798-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/18/2022] [Accepted: 07/30/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE This study reported 11 cases of new-onset acute uveitis following coronavirus disease 2019 (COVID-19) vaccination. METHODS This retrospective observational case study included 11 eyes of 11 patients with acute uveitis after the COVID-19 vaccination. We only included patients with new-onset uveitis. The medical records of the patients from January 2021 to January 2022 were reviewed. RESULTS The mean age of the participants was 51.81 years, and all patients demonstrated anterior chamber reaction with keratic precipitates in the affected eye. The mean duration between vaccination and uveitis was 8.27 days. Seven patients developed uveitis after receiving the second dose of vaccination, and four developed uveitis after receiving the third dose of vaccination. Five patients showed posterior synechiae, and three patients showed hypopyon. After treatment with topical 1% prednisolone acetate eye drops and systemic prednisolone, inflammation was adequately controlled and quickly resolved. CONCLUSIONS COVID-19 vaccination with messenger RNA and viral vector vaccines may cause acute anterior uveitis. Although initially severe, uveitis responded well to steroid therapy with no visual impairment.
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Cherif YYS, Djeffal C, Abu Serhan H, Elnahhas A, Yousef H, Katamesh BE, Abdelazeem B, Abdelaal A. The Characteristics of COVID-19 Vaccine-Associated Uveitis: A Summative Systematic Review. Vaccines (Basel) 2022; 11:69. [PMID: 36679914 PMCID: PMC9860710 DOI: 10.3390/vaccines11010069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/14/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022] Open
Abstract
Numerous complications following COVID-19 vaccination has been reported in the literature, with an increasing body of evidence reporting vaccination-associated uveitis (VAU). In this systematic review, we searched six electronic databases for articles reporting the occurrence of VAU following COVID-19 vaccination. Data were synthesized with emphasis on patients' characteristics [age, gender], vaccination characteristics [type, dose], and outcome findings [type, nature, laterality, course, location, onset, underlying cause, and associated findings]. Data are presented as numbers (percentages) for categorical data and as mean (standard deviation) for continuous data. Sixty-five studies were finally included [43 case reports, 16 case series, four cohort, one cross-sectional, and one registry-based study]. VAU occurred in 1526 cases, most commonly in females (68.93%) and middle-aged individuals (41-50 years: 19.71%), following the first dose (49.35%) of vaccination, especially in those who received Pfizer (77.90%). VAU occurred acutely (71.77%) as an inflammatory reaction (88.29%) in unilateral eyes (77.69%), particularly in the anterior portion of the uvea (54.13%). Importantly, most cases had a new onset (69.92%) while only a limited portion of cases had a reactivation of previous uveitis condition. In conclusion, although rare, uveitis following COVID-19 vaccination should be considered in new-onset and recurrent cases presenting with either acute or chronic events.
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Affiliation(s)
| | - Chakib Djeffal
- Faculty of Medicine, University of Algiers, Algiers 16311, Algeria
| | - Hashem Abu Serhan
- Tanta Research Team, El-Gharbia 31516, Egypt
- Department of Ophthalmology, Hamad Medical Corporations, Doha 576214, Qatar
| | - Ahmed Elnahhas
- Tanta Research Team, El-Gharbia 31516, Egypt
- Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Hebatallah Yousef
- Tanta Research Team, El-Gharbia 31516, Egypt
- Ophthalmology Department, Kafr Ash Shaykh Ophthalmology Hospital, Kafr Ash Shaykh 33511, Egypt
| | - Basant E. Katamesh
- Tanta Research Team, El-Gharbia 31516, Egypt
- Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Basel Abdelazeem
- Tanta Research Team, El-Gharbia 31516, Egypt
- McLaren Health Care, Flint, MI 48532, USA
- Internal Medicine Department, Michigan State University, East Lansing, Michigan, MI 48824, USA
| | - Abdelaziz Abdelaal
- Tanta Research Team, El-Gharbia 31516, Egypt
- Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Harvard Medical School, Postgraduate Medical Education, Boston, MA 02115, USA
- Doheny Eye Institute, University of California, Los Angeles, CA 90033, USA
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13
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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.
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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
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14
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There Is No Evidence That Inactivated COVID-19 Vaccines Increase Risks of Uveitis Flare. Vaccines (Basel) 2022; 10:vaccines10101680. [PMID: 36298545 PMCID: PMC9612251 DOI: 10.3390/vaccines10101680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
This is a retrospective study to investigate the impact of inactivated Coronavirus disease-2019 (COVID-19) vaccination on uveitis flare in patients with uveitis. Sixty patients that were regularly followed up for uveitis for at least two months after the last dose of inactivated COVID-19 vaccines were included in the vaccination group. Sixty patients with comparable characteristics of uveitis who had not received the COVID-19 vaccines were included in the control group. Uveitis flare within 30 days and 60 days after the vaccination in the vaccination group, or after a randomly selected date in the control group, were statistically compared. The flare rate was 16.7% (30 days) and 23.3% (60 days) in the vaccination group, while it was 13.3% (30 days) and 25% (15/60) in the control group. There was no statistical difference in the flare rate of uveitis between the two groups (p = 0.471 for 30 days, p = 0.347 for 60 days). Inactivated COVID-19 vaccination appeared not to increase the flare rate in patients with uveitis. Ophthalmologists should give proper and individualized recommendations based on the overall conditions of patients.
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15
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Kakarla PD, Venugopal RYC, Manechala UB, Rijey J, Anthwal D. Bilateral multifocal choroiditis with disc edema in a 15-year-old girl following COVID-19 vaccination. Indian J Ophthalmol 2022; 70:3420-3422. [PMID: 36018135 DOI: 10.4103/ijo.ijo_861_22] [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: 11/05/2022] Open
Abstract
A few cases of posterior uveitis following COVID-19 vaccination have been reported but none in the pediatric age group. A 15-year-old girl presented with history of headache and bilateral blurred vision of five days duration. The symptoms developed five days after vaccination with the first dose of Covaxin (inactivated SARS-CoV-2 vaccine). Her anterior segment was normal in both eyes (BE), whereas the posterior segment showed mild vitritis with disc edema and multiple yellowish lesions at the level of choroid clustered at the macula and associated with multiple serous detachments. BE uveitis resolved, and the vision was completely recovered three weeks after treatment with steroids. Hence, ophthalmologists should be aware of uveitis following vaccination-a condition that is usually benign, transient, and results in excellent outcomes with timely diagnosis and early treatment with steroids.
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Affiliation(s)
- Peeyusha D Kakarla
- Department of Retina, Sri Venkateswara Aravind Eye Hospital, Tirupathi, Andhra Pradesh, India
| | - R Y C Venugopal
- Department of Retina, Sri Venkateswara Aravind Eye Hospital, Tirupathi, Andhra Pradesh, India
| | - Upendra B Manechala
- Department of Retina, Sri Venkateswara Aravind Eye Hospital, Tirupathi, Andhra Pradesh, India
| | - Joash Rijey
- Department of Retina, Sri Venkateswara Aravind Eye Hospital, Tirupathi, Andhra Pradesh, India
| | - Deepak Anthwal
- Department of Retina, Sri Venkateswara Aravind Eye Hospital, Tirupathi, Andhra Pradesh, India
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16
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Waseem S, Ahmed SH, Fatima S, Shaikh TG, Ahmed J. SARS-CoV-2 vaccination and uveitis: Are they linked? Ann Med Surg (Lond) 2022; 81:104472. [PMID: 36060437 PMCID: PMC9420081 DOI: 10.1016/j.amsu.2022.104472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/27/2022] Open
Abstract
In 2019, the discovery of a new strain of Coronavirus, later referred to as SARS-CoV2 took the world by storm, leading to a pandemic and shutting down all global activities. Several measures were taken adequately to combat the viral havoc, including developing numerous vaccines. All the vaccines currently available for the general population went through rigorous screenings and trials to ensure maximum safety and were only approved after that. However, once they were rolled out in the markets and administered to the population, some adverse reactions were reported, one of which included uveitis. It is an ocular inflammatory condition of the uveal tract, choroid, or iris. If untreated, it can lead to severe consequences, including blindness. It is further divided into four categories based on its anatomical location. Despite the rare incidence of uveitis following COVID-19 vaccination, it may contribute to vaccine hesitancy; hence addressing and digging into the pathophysiological cause is crucial. This study evaluates all the pathophysiological and demographical links between COVID-19 vaccination and uveitis, suggesting appropriate management plans.
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Affiliation(s)
| | | | | | | | - Jawad Ahmed
- Dow University of Health Sciences, Karachi, Pakistan
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17
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Kumari S, Anand R, Sambyal B, Singh Y, Rangappa P, Jha SK. Ocular adverse effects of COVID-19 vaccines: A systematic review. J Family Med Prim Care 2022; 11:5041-5054. [PMID: 36505575 PMCID: PMC9731019 DOI: 10.4103/jfmpc.jfmpc_747_22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/04/2022] [Accepted: 06/14/2022] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has led to the development and rollout of several vaccines worldwide at unprecedented pace. This systematic review of published literature has been undertaken to spread awareness among general physicians and ophthalmologists about the various reported adverse effects in the eye following COVID-19 vaccination. A systematic search was performed on 25 January 2022 through PuBMed, Medline and Google scholar for publications on ocular adverse effects after COVID-19 vaccination. One brief communication, four retrospective case series, sixteen case reports, and five letters to editors were included. Ocular manifestations most commonly appear in the uvea and retina. Other manifestations are seen on the eyelid, cornea and ocular surface, and in cranial nerves innervating the eye. The incidence rate of these manifestations is quite low after COVID-19 vaccinations. Our systematic review meticulously enumerates various adverse effects of COVID -19 vaccine on the eye. Most of these adverse effects are transient and observed to resolve without any sequelae except for cases of retinal and ophthalmic vascular occlusions and corneal graft rejections. An emphasis on close follow-up and a need to delay vaccination and modified therapy to control flare up of signs and symptoms in certain sub-populations, Graves' disease (autoimmune etiology), pre-existing uveal inflammation and corneal graft cases are warranted. We need long-term, larger, multicentric studies to substantiate our findings and establish the causal relationship with certainty. Mass vaccinations to curb this pandemic after outweighing the ocular risks associated with it is warranted.
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Affiliation(s)
- Shalini Kumari
- Ophthalmology, AlFalah School of Medical Sciences and Research Centre, Faridabad, Haryana, India,Address for correspondence: Dr. Shalini Kumari, Al Falah School of Medical Sciences and Research Centre, Faridabad, Haryana, India. E-mail:
| | - Raj Anand
- Ophthalmology, Eye 7 Hospital, New Delhi, India
| | | | - Yudhyavir Singh
- Internal Medicine and Critical Care, AIIMS New Delhi, New Delhi, India
| | - Pradeep Rangappa
- Critical Care Medicine, Manipal Hospital, Bengluru, Karnataka, India
| | - Simant Kumar Jha
- Anaesthesiology and Critical Care, PSRI Hospital, New Delhi, India
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18
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Ren J, Zhang T, Li X, Liu G. Ocular Inflammatory Reactions following an Inactivated SARS-CoV-2 Vaccine: A Four Case Series. Ocul Immunol Inflamm 2022:1-6. [PMID: 35819841 DOI: 10.1080/09273948.2022.2093754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To report a four-case series of ocular adverse events post an inactivated COVID-19 vaccination in China. METHODS The four patients exhibited ocular inflammatory reactions on the same day after receiving an inactivated SARS-CoV-2 vaccine. RESULTS All patients underwent detailed ophthalmic examinations, with the medical diagnosis of Vogt-Koyanagi-Harada, Ponser-Schlossman, secondary post-inflammatory glaucoma, and iridocyclitis, respectively. No patients had any other underlying medical conditions causing the ocular complications. The ocular inflammatory reactions of these four patients were resolved with the administration of oral or topical corticosteroids. CONCLUSION Our cases remind the ophthalmologist that adverse ocular events may happen after the administration of SARS-CoV-2 vaccine. Since the ocular complications could be resolved with the corticosteroid treatment, the events were considered to be inflammatory reactions caused by the SARS-CoV-2 vaccine.
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Affiliation(s)
- Junhong Ren
- Department of Ophthalmology, Shanghai Tenth People's Hospital affiliated with Tongji University, Shanghai, China
| | - Tingting Zhang
- Department of Ophthalmology, Shanghai Tenth People's Hospital affiliated with Tongji University, Shanghai, China
| | - Xiaoyue Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital affiliated with Tongji University, Shanghai, China
| | - Guodong Liu
- Department of Ophthalmology, Shanghai Tenth People's Hospital affiliated with Tongji University, Shanghai, China
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19
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Chew MC, Wiryasaputra S, Wu M, Khor WB, Chan ASY. Incidence of COVID-19 Vaccination-Related Uveitis and Effects of Booster Dose in a Tertiary Uveitis Referral Center. Front Med (Lausanne) 2022; 9:925683. [PMID: 35814745 PMCID: PMC9265445 DOI: 10.3389/fmed.2022.925683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/31/2022] [Indexed: 12/30/2022] Open
Abstract
Background We report vaccine and booster-related uveitis in Singapore, a country with high vaccination and booster rates to highlight the differences and potential role of prophylactic treatment for sight-threatening infectious uveitis. Methods Clinical data extracted from the de-identified uveitis database in Singapore National Eye Center. Six patients (eight eyes) developed uveitis within 14 days after undergoing COVID-19 vaccination (primary and/or booster). Results All patients received two doses of COVID-19 vaccination, and 1.39% (6/431) developed COVID-19 vaccine-related uveitis. Fifty-percent% (3/6) with non-infectious anterior uveitis (NIAU) presented with a non-granulomatous anterior uveitis (AU). The remaining (3/6) presenting with a granulomatous AU were diagnosed with reactivation of cytomegalovirus, varicella-zoster virus and toxoplasma chorioretinitis, respectively. All the patients responded to definitive treatment specific to their diagnosis. The mean visual acuity at presentation was 0.36 ± 0.20 logMAR and improved to 0.75 ± 0.09 (p = 0.009). Mean time from vaccination to uveitis was 9.7 (range: 3–14) days. All patients developed uveitis after second vaccination dose. 16.67% (1/6) patients had a recurrence after the third booster dose. None of the three patients with infectious uveitis developed recurrence but had received maintenance therapy up to or during the booster. Conclusion Uveitis after COVID-19 vaccination is uncommon. In our series, a higher rate of reactivations of latent infections was seen. With definitive treatment, all cases were self-limited without systemic sequelae. Prophylactic treatment during booster vaccine may prevent reactivation of sight-threatening infections and reduce morbidity although risk-benefits should be considered for individual patients given the low rate of occurrence.
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Affiliation(s)
| | | | - Meihui Wu
- Translational Ophthalmic Pathology Platform, Singapore Eye Research Institute, Singapore, Singapore
| | | | - Anita S. Y. Chan
- Singapore National Eye Centre, Singapore, Singapore
- Translational Ophthalmic Pathology Platform, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore
- *Correspondence: Anita S. Y. Chan
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20
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ElSawi HA, Elborollosy A. Immune-mediated adverse events post-COVID vaccination and types of vaccines: a systematic review and meta-analysis. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022; 34:44. [PMID: 35607386 PMCID: PMC9117608 DOI: 10.1186/s43162-022-00129-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In late 2019, Coronavirus disease 2019 has been declared as a global emergency by World Health Organization. Hopefully, recent reports of effective and safe vaccines were welcomed, and approved on emergency base. Millions of recipients had received one of the approved COVID 19 vaccines, with lots of adverse events recorded global wide.
Objective
To assess post-COVID vaccination immune-mediated adverse events and evaluate its association to specific type of vaccine global wide.
Methods
Systematic literature review and meta-analysis of published reports (since December 2020 till December 2021) on immune-mediated adverse events post-COVID vaccination.
Results
We evaluated 34 published studies; 460 cases with various adverse events post-COVID vaccination. Studies in current literature are primarily retrospective case series, isolated case reports or narrative studies. Different COVID vaccines were involved. Results’ data was subcategorized according to associated vaccine. Adverse effects of COVID-19 vaccinations included thrombotic, neurological, myocarditis, ocular, dermatological, renal, hematological events timely linked to inoculation. Each vaccine type was linked to adverse profile that differ from others.
Conclusion
High suspicion of post-vaccination adverse events is mandatory to provoke earlier detection, better understanding, optimum prevention, and management. Specific vaccine/patient risk profile is needed to selectively categorize target population to reduce morbidity and mortality post-vaccination.
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21
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Ding X, Chang Q. Probable Vogt–Koyanagi–Harada Disease after COVID-19 Vaccination: Case Report and Literature Review. Vaccines (Basel) 2022; 10:vaccines10050783. [PMID: 35632539 PMCID: PMC9146171 DOI: 10.3390/vaccines10050783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/05/2023] Open
Abstract
COVID-19 vaccination is considered the most effective and promising approach for the elimination of the SARS-CoV-2 pandemic globally. Although the vaccine has been proven to be safe, as evidenced by the promotion of mass vaccination, new side effects, including several ocular complications that were not described during the experimental stage, are now emerging. In the present study, we report a 33-year-old Chinese man who developed probable Vogt–Koyanagi–Harada (VKH) disease only one day after his first dose of an inactivated COVID-19 vaccine, without any systemic symptoms. His medical history was unremarkable, except for hypertension. Although successfully relieved by oral prednisone, the patient progressed to the chronic stage of VKH disease with ocular depigmentation 4 months after onset. By reviewing similar cases previously reported, we discuss and summarize the common characteristics of VKH disease associated with vaccines against SARS-CoV-2, as well as the possible mechanisms behind this phenomenon. Although the causality is unclear, ophthalmologists and generalists should be aware of this possible ocular adverse effect after COVID-19 vaccination.
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Affiliation(s)
- Xinyi Ding
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China;
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
| | - Qing Chang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China;
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- Correspondence:
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22
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Al-Allaf AW, Razok A, Al-Allaf Y, Aker L. Post-COVID-19 vaccine medium-vessel vasculitis and acute anterior uveitis, causation vs temporal relation; case report and literature review. Ann Med Surg (Lond) 2022; 75:103407. [PMID: 35228869 PMCID: PMC8867999 DOI: 10.1016/j.amsu.2022.103407] [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: 01/13/2022] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction and importance: Multiple immunologic phenomena were reported following the administration of COVID-19 vaccines. However, the important point is that their possible association with medium-vessel vasculitis involving the celiac trunk and its branches with acute anterior uveitis in the same patient has not been reported before. Case presentation In this manuscript, we are reporting a case of a middle-aged gentleman who developed vasculitis involving the celiac trunk and its branches, and acute anterior uveitis one week and three weeks after the second dose of Pfizer BioNTech COVID-19 vaccine, respectively. The patient showed significant clinical and radiographic improvement after receiving corticosteroids and azathioprine. Clinical discussion Previously reported cases of vasculitis following COVID-19 vaccines included both renal-limited and more generalized vasculitis with some being positive and others negative for ANCA (anti-neutrophil cytoplasmic antibodies). Nevertheless, it is worth mentioning that most cases responded to immunosuppressive treatment. Post-COVID-19 vaccine uveitis was reported in patients with different age spans including both anterior and posterior uveitis, with remission being achieved after the use of corticosteroids. Conclusions Multiple cases of vasculitis and acute anterior uveitis were reported following COVID-19 vaccines; however, it is important to mention that more research is needed to establish an association between the COVID-19 vaccine and both vasculitis and acute anterior uveitis. In our opinion, the benefits of the COIVID-19 vaccine largely outweigh the expected risks. This is the first case report for medium vessel vasculitis after a COVID-19 vaccine. The association could be casual or by chance. More studies are needed to assert the nature of this association. We think that this is a transient condition and it could be managed in the same line for managing vasculitis. This should not deter us from using the COVID vaccine, which is essential to alter the course of the COVID epidemic.
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Affiliation(s)
| | - Almurtada Razok
- Department of Internal Medicine, Hamad Medical Corporation, P.O 3050, Doha, Qatar
| | - Yousr Al-Allaf
- Imperial College School of Medicine, London, United Kingdom
| | - Loai Aker
- Department of Radiology, Hamad Medical Corporation, P.O 3050, Doha, Qatar
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Ocular Complications Following Vaccination for COVID-19: A One-Year Retrospective. Vaccines (Basel) 2022; 10:vaccines10020342. [PMID: 35214800 PMCID: PMC8875181 DOI: 10.3390/vaccines10020342] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/24/2022] Open
Abstract
Vaccination efforts as a mitigation strategy in the corona virus disease 2019 (COVID-19) pandemic are fully underway. A vital component of understanding the optimal clinical use of these vaccines is a thorough investigation of adverse events following vaccination. To date, some limited reports and reviews have discussed ocular adverse events following COVID-19 vaccination, but a systematic review detailing these reports with manifestations and clinical courses as well as proposed mechanisms has yet to be published. This comprehensive review one-year into vaccination efforts against COVID-19 is meant to furnish sound understanding for ophthalmologists and primary care physicians based on the existing body of clinical data. We discuss manifestations categorized into one of the following: eyelid, orbit, uveitis, retina, vascular, neuro-ophthalmology, ocular motility disorders, and other.
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Matsuo T, Honda H, Tanaka T, Uraguchi K, Kawahara M, Hagiya H. COVID-19 mRNA Vaccine-Associated Uveitis Leading to Diagnosis of Sarcoidosis: Case Report and Review of Literature. J Investig Med High Impact Case Rep 2022; 10:23247096221086450. [PMID: 35313760 PMCID: PMC8943455 DOI: 10.1177/23247096221086450] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/14/2022] [Accepted: 02/20/2022] [Indexed: 12/02/2022] Open
Abstract
A 34-year-old Japanese person with male gender identity who had been taking intramuscular injection of methyltestosterone depot for 11 years after bilateral mastectomy noticed blurred vision 5 days after the second vaccination for COVID-19 (Tozinameran; Pfizer-BioNTech) in the interval of 3 weeks following the first vaccination. The patient was diagnosed as granulomatous iritis with mutton-fat keratic precipitates and small iris nodules at the pupillary margin in the right eye and began to have 0.1% betamethasone eye drops with good response. The patient, however, continued to have fever and malaise and showed a high level of serum soluble interleukin-2 receptor (sIL-2R) even 4 weeks after the second vaccination. Computed tomographic scan disclosed mediastinal and bilateral hilar small lymphadenopathy together with limited granular lesion in the right lung. Gallium-67 scintigraphy demonstrated high uptake not only in mediastinal and hilar lymph nodes but also in bilateral parotid glands. Right parotid gland biopsy revealed noncaseating granulomas and proved pathological diagnosis of sarcoidosis. The systemic symptoms were relieved by oral prednisolone 20 mg daily. Even though the causal relationship remains undetermined, this case is unique at the point that vaccine-associated uveitis led to the detection of pulmonary lesions and lymphadenopathy, resulting in clinical and pathological diagnosis of sarcoidosis. In literature review, 3 patients showed sarcoidosis-like diseases after COVID-19 vaccination: 2 patients were diagnosed clinically as Lofgren syndrome with acute onset of erythema nodosum and ankle swelling, with or without mediastinal and hilar lymphadenopathy, whereas 1 patient with mediastinal lymphadenopathy but no uveitis was diagnosed pathologically by biopsy as sarcoidosis.
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Affiliation(s)
- Toshihiko Matsuo
- Graduate School of Interdisciplinary
Science and Engineering in Health Systems, Okayama University, Japan
- Department of Ophthalmology, Okayama
University Hospital, Japan
| | - Hiroyuki Honda
- Department of General Medicine, Okayama
University Hospital, Japan
| | - Takehiro Tanaka
- Department of Pathology, Graduate
School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University,
Japan
| | - Kensuke Uraguchi
- Department of Otolaryngology, Head
& Neck Surgery, Okayama University Hospital, Japan
| | | | - Hideharu Hagiya
- Department of General Medicine, Okayama
University Hospital, Japan
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Coronavirus-vaccine-Wuhan-Institute-of-Biological-Products. REACTIONS WEEKLY 2021. [PMCID: PMC8642221 DOI: 10.1007/s40278-021-06460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sen M, Honavar SG. After the Storm: Ophthalmic Manifestations of COVID-19 Vaccines. Indian J Ophthalmol 2021; 69:3398-3420. [PMID: 34826968 PMCID: PMC8837328 DOI: 10.4103/ijo.ijo_2824_21] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/22/2022] Open
Abstract
Several COVID-19 vaccines have been developed and approved for use around the world from December 2020, to combat the pandemic caused by the novel SARS-CoV-2 virus. Several ophthalmic manifestations of the COVID-19 vaccines have been reported by ophthalmologists. This review was undertaken to recognize, encourage active reporting and determine the pathogenesis and time of appearance for better awareness and understanding of the ophthalmic manifestations of COVID-19 vaccines. A literature search was performed for publications on the ophthalmic manifestations of COVID-19 vaccines between January 1, 2021 and November 7, 2021. 23 case reports, 17 letters to editors, 3 ophthalmic images, 4 brief communications, 4 retrospective cohort studies and 2 case control studies were included. Posterior segment, including the uvea, choroid and retinal vasculature, was most commonly affected and the reported clinical features developed at a median of four days from the time of vaccination. The possible mechanisms include molecular mimicry of the vaccine components with host ocular tissues, antigen-specific cell and antibody-mediated hypersensitivity reactions to viral antigens and adjuvants present in the vaccines. The causal relationship of the ocular signs and symptoms and COVID-19 vaccines has not been established and requires long-term and large multicentre data. Most of the reported manifestations are mild, transient and adequately treated when diagnosed and managed early. The benefits of COVID-19 vaccination outweighs the reported rare adverse events and should not be a deterrent to vaccination.
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Affiliation(s)
- Mrittika Sen
- Ophthalmic and Facial Plastic Surgery and Ocular Oncology Service, Centre for Sight, Hyderabad, Telangana, India
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Santosh G Honavar
- Ophthalmic and Facial Plastic Surgery and Ocular Oncology Service, Centre for Sight, Hyderabad, Telangana, India
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