1
|
Marzoog BA. Manifestations of COVID-19 in the posterior eye segment - Up-to-date. Oman J Ophthalmol 2024; 17:166-172. [PMID: 39132129 PMCID: PMC11309540 DOI: 10.4103/ojo.ojo_212_22] [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: 07/18/2022] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 08/13/2024] Open
Abstract
Since coronavirus disease infection-19 (COVID-19) entry to the cells is angiotensin enzyme receptor (ACEII) dependent, extrapulmonary manifestations have been suspected. Ocular manifestations reported in several studies to involve the anterior as well as posterior eye segments. However, the predominance of the anterior eye segment reduced the attention of the scientific community on the posterior eye segment. Our results showed that the incidence of changes in the posterior eye segment is 1/5 of the anterior eye segment. Posterior eye segment manifestations include acute macular neuroretinopathy and paracentral middle maculopathy, central retinal vein/artery occlusion, reactivation of previous uveitis, varicella zoster virus-related acute retinal necrosis in an immunocompromised patient, chorioretinitis, macular hemorrhage, paracentral acute middle maculopathy, retinal detachment, and vitritis with outer retinal abnormalities. The pathogenesis of posterior eye segment manifestations under COVID-19 includes viremia, autoimmune vasculitis, hyperimmune response, coagulopathy, and cytokine storm. A full ophthalmological examination is crucial for patients recovering from COVID-19. The paper provided up-to-date manifestations with potential underlying pathophysiological mechanisms of development, as well as pathogenetic therapy.
Collapse
Affiliation(s)
- Basheer Abdullah Marzoog
- World-Class Research Center “Digital Biodesign and Personalized Healthcare,” I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| |
Collapse
|
2
|
Furukawa A, Suzuki Y, Nozuki N, Kurosaka N, Kogawa S, Hara S, Ueno S. Case report: A case of unilateral combined central retinal vein occlusion, incomplete central retinal artery occlusion, and papillitis following a third dose of COVID-19 vaccination. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1352962. [PMID: 38984132 PMCID: PMC11182238 DOI: 10.3389/fopht.2024.1352962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/29/2024] [Indexed: 07/11/2024]
Abstract
Purpose The aim of this study was to present a case of severe visual loss due to retinal arteriovenous occlusion and papillitis in one eye following vaccination against coronavirus disease (COVID-19). Methods A 45-year-old man undergoing treatment for hypertension had severely reduced visual acuity in the right eye 1 day after receiving a third dose of a COVID-19 vaccine manufactured by Moderna. Clinical examination showed that the best-corrected visual acuity in the right eye was counting fingers. Other findings included circumferential retinal hemorrhage, perimacular ischemic color, severe macular edema, and severe optic disc swelling, indicating the presence of central retinal vein occlusion, incomplete central retinal artery occlusion, and papillitis. Based on the possibility of post-vaccination inflammation and/or abnormal immune response, three courses of steroid pulse therapy were administered, and the visual acuity slightly improved to 20/1,000. Results Three months after the onset of symptoms, macular edema disappeared; conversely, retinal thinning of the macula and extensive non-perfusion areas mainly on the nasal side were noted. Conclusion The findings in this case suggest that inflammation and abnormal immune response after receiving a COVID-19 vaccination may lead to combined retinal arteriovenous occlusion and papillitis.
Collapse
Affiliation(s)
- Ami Furukawa
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yukihiko Suzuki
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Narumi Nozuki
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naruki Kurosaka
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satomi Kogawa
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Shinji Ueno
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
3
|
Yeung M, Su CKY, Au SCL. Vaccine-related retinal artery occlusion in adults: a review of the current literature. J Stroke Cerebrovasc Dis 2023; 32:106694. [PMID: 35953410 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Maggie Yeung
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | - Sunny Chi Lik Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong.
| |
Collapse
|
4
|
Sadeghi E, Mahmoudzadeh R, Garg SJ, Nowroozzadeh MH. Ocular posterior segment complications following COVID-19 vaccination. Int Ophthalmol 2023; 43:4343-4357. [PMID: 37432598 DOI: 10.1007/s10792-023-02795-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/22/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND The SARS-CoV-2 pandemic has had a significant impact on healthcare, including eye care, worldwide. Effective and safe vaccines have been developed using both conventional and novel technologies to combat SARS-CoV-2 infection. While vaccination has been shown to be remarkably effective in reducing the spread and associated morbidity and mortality of COVID-19 disease, there have been reports of complications to the posterior segment of the eye. METHODS We present a case-based analysis of reported complications of COVID-19 vaccination to the posterior segment of the eye. The study aims to highlight the diversity of possible complications and discuss the plausible involved pathophysiologic mechanisms. RESULTS The most significant complications reported were retinal macro or microvascular occlusions, uveitis, and central serous chorioretinopathy. These complications are rare but require prompt diagnosis and management to prevent serious visual morbidity. CONCLUSIONS Our study highlights the need for ophthalmologists to be aware of possible complications related to COVID-19 vaccination and the importance of prompt diagnosis and management. The findings of this study may help ophthalmologists to better understand and manage these rare complications.
Collapse
Affiliation(s)
- Elham Sadeghi
- Department of Ophthalmology, Shiraz University of Medical Sciences, Poostchi Clinic, Zand Street, Shiraz, 7134997446, Iran
| | - Raziyeh Mahmoudzadeh
- MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sunir J Garg
- MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Hossein Nowroozzadeh
- Department of Ophthalmology, Shiraz University of Medical Sciences, Poostchi Clinic, Zand Street, Shiraz, 7134997446, Iran.
| |
Collapse
|
5
|
Nune A, Durkowski V, Pillay SS, Barman B, Elwell H, Bora K, Bilgrami S, Mahmood S, Babajan N, Venkatachalam S, Ottewell L, Manzo C. New-Onset Rheumatic Immune-Mediated Inflammatory Diseases Following SARS-CoV-2 Vaccinations until May 2023: A Systematic Review. Vaccines (Basel) 2023; 11:1571. [PMID: 37896974 PMCID: PMC10610967 DOI: 10.3390/vaccines11101571] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
A comprehensive, up-to-date systematic review (SR) of the new-onset rheumatic immune-mediated inflammatory diseases (R-IMIDs) following COVID-19 vaccinations is lacking. Therefore, we investigated the demographics, management, and prognosis of new R-IMIDs in adults following SARS-CoV-2 vaccinations. A systematic literature search of Medline, Embase, Google Scholar, LitCovid, and Cochrane was conducted. We included any English-language study that reported new-onset R-IMID in adults following the post-COVID-19 vaccination. A total of 271 cases were reported from 39 countries between January 2021 and May 2023. The mean age of patients was 56 (range 18-90), and most were females (170, 62.5%). Most (153, 56.5%) received the Pfizer BioNTech COVID-19 vaccine. Nearly 50% of patients developed R-IMID after the second dose of the vaccine. Vasculitis was the most prevalent clinical presentation (86, 31.7%), followed by connective tissue disease (66, 24.3%). The mean duration between the vaccine's 'trigger' dose and R-IMID was 11 days. Most (220, 81.2%) received corticosteroids; however, 42% (115) received DMARDs such as methotrexate, cyclophosphamide, tocilizumab, anakinra, IV immunoglobulins, plasma exchange, or rituximab. Complete remission was achieved in 75 patients (27.7%), and 137 (50.6%) improved following the treatment. Two patients died due to myositis. This SR highlights that SARS-CoV-2 vaccines may trigger R-IMID; however, further epidemiology studies are required.
Collapse
Affiliation(s)
- Arvind Nune
- Department of Rheumatology, Southport and Ormskirk NHS Trust, Southport PR8 6PN, UK
| | - Victor Durkowski
- Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L9 7AL, UK
| | | | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati 781101, India
| | - Helen Elwell
- BMA Library, BMA House, Tavistock Square, British Medical Association, London WC1H 9JP, UK
| | - Kaustubh Bora
- Haematology Division, ICMR-Regional Medical Research Centre, Dibrugarh 786001, India
| | - Syed Bilgrami
- Department of Rheumatology, Royal Lancaster Infirmary, Lancaster LA1 4RP, UK
| | - Sajid Mahmood
- Department of Medicine, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK
| | - Nasarulla Babajan
- Department of Medicine, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK
| | | | - Lesley Ottewell
- Department of Rheumatology, Royal Lancaster Infirmary, Lancaster LA1 4RP, UK
| | - Ciro Manzo
- Rheumatologic Outpatient Clinic, Azienda Sanitaria Locale Napoli 3, 80065 Sant'Agnello, Italy
| |
Collapse
|
6
|
Rachman MJ, Kalanjati VP, Rimbun R, Khadijah F. Retinal Vein Occlusion Amongst People Vaccinated by mRNA- and Viral Vector- COVID-19 Vaccines: A Systematic Review. Clin Ophthalmol 2023; 17:2825-2842. [PMID: 37794952 PMCID: PMC10545804 DOI: 10.2147/opth.s426428] [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: 06/17/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
Vaccines are highly effective in lowering the mortality due to COVID-19. Although several suspected adverse events or side effects after vaccination including retinal vein occlusion (RVO) have been reported. We conducted a systematic review using PRISMA methods to analyze the occurrence of RVO among people vaccinated by COVID-19 mRNA- vs viral vector- vaccines on 4 databases from 1-1-2021 to 31-12-2022 using specified MeSH terms. All included studies were assessed using JBI critical appraisal tools for eligibility. The final included studies are 31 studies (n=78 cases from 75 patients; 3 of these patients suffered twice). The median age of the patients was 61 years (28 to 96 years old) and most of them were female (52.00%). Thirty-nine patients received the mRNA vaccine (52.00%), while 36 patients received the viral vector vaccine (48.00%) before the event. The RVO diagnoses are based on physical examination confirmed by Fluorescein Angiography (FA), and/or Optical Coherence Tomography (OCT). The median time interval between vaccination and RVO was 6 days in the mRNA vaccine group and 4 days in the viral vector vaccine group. Central retinal vein occlusion (CRVO) and Branch Retinal Vein Occlusion (BRVO) were tied as the most common diagnosis in the mRNA vaccine group (20.51% and 20.51%), whilst in the viral vector vaccine group CRVO was the most common diagnosis (17.94%). Most of these cases had good outcomes with improved visual impairment in one or both eyes. From this review, we could not ascertain that the RVO occurs due to the type of COVID-19 vaccines because of the detailed data on the dosage and the history of illness of each patient. However, the awareness that the RVO could develop after COVID-19 vaccination must be taken into consideration, even though it is rare.
Collapse
Affiliation(s)
- Maria Jessica Rachman
- Master Program of Basic Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Faculty of Medicine, Universitas Ciputra, Surabaya, East Java, Indonesia
| | - Viskasari P Kalanjati
- Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Rimbun Rimbun
- Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Fira Khadijah
- Master Program of Basic Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| |
Collapse
|
7
|
Leung HM, Au SCL. Retinal Vein Occlusion after COVID-19 Vaccination-A Review. Vaccines (Basel) 2023; 11:1281. [PMID: 37631850 PMCID: PMC10459858 DOI: 10.3390/vaccines11081281] [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: 06/20/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023] Open
Abstract
Background Retinal vein occlusion (RVO) occurring after COVID-19 vaccination has been reported worldwide. Such a sight-threatening condition occurring after COVID-19 vaccination is a menace to ophthalmic health. This article reviews current evidence related to post-COVID-19 vaccination RVO. Method A total of 29 relevant articles identified on PubMed in January 2023 were selected for review. Observation All cases presented to ophthalmologists with visual loss shortly after COVID-19 vaccination. Mean and median age were both 58. No sex predominance was observed. RVO was diagnosed from findings on dilated fundal examination and ophthalmic imaging. AstraZeneca and BNT vaccines accounted for most cases. Vascular risk factors, e.g., diabetes mellitus and hypertension, were common. Most laboratory tests requested came back unremarkable. Most patients responded well to standard treatment, except those with ophthalmic comorbidities. Visual prognosis was excellent on short-term follow-up. Discussion The causality between RVO and COVID-19 vaccination is undeterminable because of the nature of articles, heterogenous reporting styles, contradicting laboratory findings and co-existing vascular risk factors. Vaccine-induced immune thrombotic thrombocytopenia, retinal vasculitis and homocysteinaemia were proposed to explain post-vaccination RVO. Large-scale studies have demonstrated that the incidence of RVO following COVID vaccination is very low. Nevertheless, the effects of boosters on retinal vasculature and ophthalmic health are still unclear. Conclusions The benefits of COVID-19 vaccination are believed to outweigh its ophthalmic risks. To ensure safe vaccination, the prior optimisation of comorbidities and post-vaccination monitoring are important. COVID-19 vaccines (including boosters) should be offered with reasonable confidence. Further studies are warranted to elucidate the ophthalmic impact of vaccines.
Collapse
Affiliation(s)
- Ho-Man Leung
- Hospital Authority, Ma Tau Wai 999077, Hong Kong
| | - Sunny Chi-Lik Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, So Kon Po 999077, Hong Kong
| |
Collapse
|
8
|
Yeo S, Kim H, Lee J, Yi J, Chung YR. Retinal vascular occlusions in COVID-19 infection and vaccination: a literature review. Graefes Arch Clin Exp Ophthalmol 2023; 261:1793-1808. [PMID: 36598554 PMCID: PMC9811047 DOI: 10.1007/s00417-022-05953-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Abnormal hypercoagulability and increased thromboembolic risk are common in patients with coronavirus disease (COVID-19). COVID-19 has been suggested to cause retinal vascular damage, with several studies on COVID-19 patients with retinal vascular occlusions. We reviewed and investigated studies on retinal vascular occlusions in patients diagnosed with COVID-19 and in those vaccinated for COVID-19. METHODS Studies that reported retinal vascular occlusion in COVID-19 patients or in vaccinated people were identified using the terms "retinal occlusion," together with "severe acute respiratory syndrome coronavirus 2", "SARS-CoV-2," "COVID-19," "coronavirus," and "vaccine," through systematic searches of PubMed and Google Scholar databases until January 7, 2022. RESULTS Thirteen cases of retinal artery occlusion (RAO) and 14 cases of retinal vein occlusion (RVO) were identified among patients diagnosed with COVID-19. Half of the patients with RAO or RVO revealed no systemic disorders except current or past COVID-19, and ocular symptoms were the initial presentation in five cases. Among patients with RAO, most presented with central RAO at 1-14 days of COVID-19 diagnosis, with abnormal coagulation and inflammatory markers. Among those with RVO, two-thirds presented with central RVO and one-third with RVO. Eleven cases with acute macular neuroretinopathy (AMN) and/or paracentral acute middle maculopathy (PAMM) were reported among patients with COVID-19, presenting scotoma resolved spontaneously in most cases. Among the 26 cases vaccinated with either mRNA or adenoviral vector vaccines for COVID-19 and presenting retinal vascular occlusions, there were more RVO cases than RAO cases, and ocular symptoms mostly occurred within 3 weeks after vaccination. One case presented bilateral AMN and PAMM after COVID-19 vaccination. CONCLUSION Retinal vascular occlusions might be a manifestation of COVID-19, although rare, especially in patients at risk of systemic hypercoagulability and thromboembolism. For COVID-19 vaccines, the causal relationship is controversial because there are few case reports of retinal vascular occlusions after COVID-19 vaccination.
Collapse
Affiliation(s)
- Suji Yeo
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-Ro, Yeongtong-Gu, Suwon, 16499, Korea
| | - Hanju Kim
- Special Study Module, Ajou University School of Medicine, Suwon, Korea
| | - Jiwon Lee
- Special Study Module, Ajou University School of Medicine, Suwon, Korea
| | - Jeonghyun Yi
- Special Study Module, Ajou University School of Medicine, Suwon, Korea
| | - Yoo-Ri Chung
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-Ro, Yeongtong-Gu, Suwon, 16499, Korea.
| |
Collapse
|
9
|
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
|
10
|
Dinkin M, Sathi S. Neuro-Ophthalmic Visual Impairment in the Setting of COVID-19. Semin Neurol 2023. [PMID: 37311536 DOI: 10.1055/s-0043-1767715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We set out to describe in detail the afferent neuro-ophthalmological complications that have been reported in association with coronavirus disease 2019 (COVID-19) infection. We describe and elaborate on mechanisms of disease, including para-infectious inflammation, hypercoagulability, endothelial damage, and direct neurotropic viral invasion. Despite global vaccination programs, new variants of COVID-19 continue to pose an international threat, and patients with rare neuro-ophthalmic complications are likely to continue to present for care.Afferent complications from COVID-19 include homonymous visual field loss, with or without higher cortical visual syndromes, resulting from stroke, intracerebral hemorrhage, or posterior reversible leukoencephalopathy. Optic neuritis has frequently been reported, sometimes along with acute disseminated encephalomyelopathy, often in association with either myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) or less commonly aquaporin-4 seropositivity or in newly diagnosed multiple sclerosis. Ischemic optic neuropathy has rarely been reported. Papilledema, resulting either from venous sinus thrombosis or idiopathic intracranial hypertension in the setting of COVID-19, has also been described.Observed afferent neuro-ophthalmic associations need to be confirmed though larger comparative studies. Meanwhile, the range of possible complications should be recognized by neurologists and ophthalmologists alike, to facilitate faster diagnosis and treatment of both COVID-19 and its neuro-ophthalmic manifestations.
Collapse
Affiliation(s)
- Marc Dinkin
- Department of Ophthalmology, Weill Cornell Medical College, NY Presbyterian Hospital, New York, New York
- Department of Neurology, Weill Cornell Medical College, NY Presbyterian Hospital, New York, New York
| | | |
Collapse
|
11
|
Scholkmann F, May CA. COVID-19, post-acute COVID-19 syndrome (PACS, "long COVID") and post-COVID-19 vaccination syndrome (PCVS, "post-COVIDvac-syndrome"): Similarities and differences. Pathol Res Pract 2023; 246:154497. [PMID: 37192595 DOI: 10.1016/j.prp.2023.154497] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
Worldwide there have been over 760 million confirmed coronavirus disease 2019 (COVID-19) cases, and over 13 billion COVID-19 vaccine doses have been administered as of April 2023, according to the World Health Organization. An infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to an acute disease, i.e. COVID-19, but also to a post-acute COVID-19 syndrome (PACS, "long COVID"). Currently, the side effects of COVID-19 vaccines are increasingly being noted and studied. Here, we summarise the currently available indications and discuss our conclusions that (i) these side effects have specific similarities and differences to acute COVID-19 and PACS, that (ii) a new term should be used to refer to these side effects (post-COVID-19 vaccination syndrome, PCVS, colloquially "post-COVIDvac-syndrome"), and that (iii) there is a need to distinguish between acute COVID-19 vaccination syndrome (ACVS) and post-acute COVID-19 vaccination syndrome (PACVS) - in analogy to acute COVID-19 and PACS ("long COVID"). Moreover, we address mixed forms of disease caused by natural SARS-CoV-2 infection and COVID-19 vaccination. We explain why it is important for medical diagnosis, care and research to use the new terms (PCVS, ACVS and PACVS) in order to avoid confusion and misinterpretation of the underlying causes of disease and to enable optimal medical therapy. We do not recommend to use the term "Post-Vac-Syndrome" as it is imprecise. The article also serves to address the current problem of "medical gaslighting" in relation to PACS and PCVS by raising awareness among the medical professionals and supplying appropriate terminology for disease.
Collapse
Affiliation(s)
- Felix Scholkmann
- University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Christian-Albrecht May
- Department of Anatomy, Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| |
Collapse
|
12
|
Dorney I, Shaia J, Kaelber DC, Talcott KE, Singh RP. Risk of New Retinal Vascular Occlusion After mRNA COVID-19 Vaccination Within Aggregated Electronic Health Record Data. JAMA Ophthalmol 2023; 141:441-447. [PMID: 37052897 PMCID: PMC10102921 DOI: 10.1001/jamaophthalmol.2023.0610] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/31/2023] [Indexed: 04/14/2023]
Abstract
Importance New-onset retinal vascular occlusion (RVO) occurring acutely after messenger RNA (mRNA) COVID-19 vaccination has been described in recent literature. Because RVO can cause vision loss or blindness, an epidemiologic investigation evaluating this potential association is of great importance to public health. Objective To investigate how often patients are diagnosed with new RVO acutely after the mRNA COVID-19 vaccine compared with influenza and tetanus, diphtheria, pertussis (Tdap) vaccines. Design, Setting, and Participants A retrospective population-based cohort design using the TriNetX Analytics platform, a federated, aggregated electronic health record (EHR) research network containing the deidentified EHR data of more than 103 million patients, was used to examine aggregate EHR data. Data were collected and analyzed on October 20, 2022. Data on patients within the TriNetX Analytics platform were searched for the presence of vaccination Common Procedural Technology codes, and instances of newly diagnosed RVO within 21 days of vaccination were recorded and reported. Propensity score matching based on demographic characteristics (age, sex, race and ethnicity) and comorbidities (diabetes, hypertension, and hyperlipidemia) was performed between vaccination groups for evaluation of relative risks (RRs). Main Outcomes and Measures The appearance of a new-encounter diagnosis of RVO within 21 days of the mRNA COVID-19 vaccination was the primary outcome. Historical comparison cohorts of patients receiving influenza and Tdap vaccinations allowed for evaluation of the RRs for RVO. Results Of 3 108 829 patients (mean [SD] age at vaccination, 50.7 [20.4] years; 56.4% women) who received the mRNA COVID-19 vaccine, 104 (0.003%; 95% CI, 0.003%-0.004%) patients had a new diagnosis of RVO within 21 days of vaccination. After propensity score matching, the RR for new RVO diagnosis after the first dose of COVID-19 vaccination was not significantly different from that after influenza (RR, 0.74; 95% CI, 0.54-1.01) or Tdap (RR, 0.78; 95% CI, 0.44-1.38) vaccinations, but was greater when compared with the second dose of the COVID-19 vaccination (RR, 2.25; 95% CI, 1.33-3.81). Conclusions and Relevance The findings of this study suggest that RVO diagnosed acutely after mRNA COVID-19 vaccination occurs extremely rarely at rates similar to those of 2 different historically used vaccinations, the influenza and Tdap vaccines. No evidence suggesting an association between the mRNA COVID-19 vaccination and newly diagnosed RVO was found.
Collapse
Affiliation(s)
- Ian Dorney
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jacqueline Shaia
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Katherine E. Talcott
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi P. Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
13
|
Sung SY, Jenny LA, Chang YC, Wang NK, Liu PK. Central Retinal Vein Occlusion in a Young Woman with Diabetes and Hypertension after mRNA-Based COVID-19 Vaccination-A Case Report and Brief Review of the Literature. Vaccines (Basel) 2023; 11:365. [PMID: 36851242 PMCID: PMC9960341 DOI: 10.3390/vaccines11020365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
A 25-year-old female with diabetes and hypertension presented with progressive painless blurred vision in her left eye ten days after she received her third dose of the SARS-CoV-2 mRNA vaccine BNT162b2 (Pfizer-BioNTech). The clinical examination confirmed the diagnosis of Central Retinal Vein Occlusion (CRVO) complicated with macular edema. Three doses of anti-vascular endothelial growth factor (VEGF) were injected intravitreally. Visual acuity was improved from 20/100 to 20/30, but recurrence was noted at 6 months. Several cases of retinal vein occlusion (RVO) after COVID-19 vaccination have been reported. However, the present case is the youngest female individual documented to have CRVO after SARS-CoV-2 vaccination. This case demonstrates that the macular edema might be recurrent in patients with risk factors for CRVO who receive SARS-CoV-2 vaccination, suggesting the need for careful consideration of the treatment strategy and close follow-up. Although the definite pathogenesis still needs to be carefully determined, this report highlights the possible association between RVO and mRNA-based COVID-19 vaccination, even in young individuals.
Collapse
Affiliation(s)
- Shao-Yu Sung
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Laura A. Jenny
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Yo-Chen Chang
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Pei-Kang Liu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| |
Collapse
|
14
|
Abu Serhan H, Abdelaal A, Abuawwad MT, Taha MJJ, Irshaidat S, Abu Serhan L, Abu-Ismail L, Abu Salim QF, Abdelazeem B, Elnahry AG. Ocular Vascular Events following COVID-19 Vaccines: A Systematic Review. Vaccines (Basel) 2022; 10:2143. [PMID: 36560553 PMCID: PMC9786009 DOI: 10.3390/vaccines10122143] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 12/16/2022] Open
Abstract
The main aim of this study is to investigate the current evidence regarding the association between COVID-19 vaccination and ocular vascular events. The protocol is registered on PROSPERO (CRD42022358133). On 18 August 2022, an electronic search was conducted through five databases. All original articles reporting individuals who were vaccinated with COVID-19 vaccines and developed ophthalmic vascular events were included. The methodological quality of the included studies was assessed using the NIH tool. A total of 49 studies with 130 ocular vascular cases were included. Venous occlusive events were the most common events (54.3%), which mostly occurred following the first dose (46.2%) and within the first five days following vaccination (46.2%). Vascular events occurred more with the Pfizer and AstraZeneca vaccines (81.6%), and mostly presented unilaterally (73.8%). The most frequently reported treatment was intravitreal anti-VEGF (n = 39, 30.4%). The majority of patients (90.1%) demonstrated either improvement (p = 0.321) or persistence (p = 0.414) in the final BCVA. Ophthalmic vascular events are serious vision-threatening side effects that have been associated with COVID-19 vaccination. Clinicians should be aware of the possible association between COVID-19 vaccines and ocular vascular events to provide early diagnosis and treatment.
Collapse
Affiliation(s)
- Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporations, Doha 3050, Qatar
- Tanta Research Team, El-Gharbia 31511, Egypt
| | - Abdelaziz Abdelaal
- Tanta Research Team, El-Gharbia 31511, Egypt
- Harvard Medical School, Postgraduate Medical Education, Boston, MA 02115, USA
- Doheny Eye Institute, University of California, Los Angeles, CA 94720, USA
| | - Mohammad T. Abuawwad
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| | - Mohammad J. J. Taha
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| | - Sara Irshaidat
- Department of Pediatrics, King Hussein Cancer Centre, Amman 11941, Jordan
| | - Leen Abu Serhan
- Faculty of Medicine, Hashemite University, Zarqa 13133, Jordan
| | - Luai Abu-Ismail
- Department of Ophthalmology, Islamic Hospital, Amman 11190, Jordan
| | | | - Basel Abdelazeem
- Tanta Research Team, El-Gharbia 31511, Egypt
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Ayman G. Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo 11591, Egypt
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| |
Collapse
|
15
|
Au SCL. Comments on: After the Storm: Ophthalmic Manifestations of COVID-19 Vaccines. Indian J Ophthalmol 2022; 70:3737-3738. [PMID: 36190094 PMCID: PMC9789869 DOI: 10.4103/ijo.ijo_1483_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Sunny Chi Lik Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong,Correspondence to: Dr. Sunny Chi Lik Au, 9/F, MO Office, Lo Ka Chow Memorial Ophthalmic Centre, Tung Wah Eastern Hospital, 19 Eastern Hospital Road, Causeway Bay, Hong Kong. E-mail:
| |
Collapse
|
16
|
Nangia P, Prakash VJ, Dutta Majumder P. Retinal venous occlusion in a child following Corbevax COVID-19 vaccination. Indian J Ophthalmol 2022; 70:3713-3715. [PMID: 36190080 PMCID: PMC9789814 DOI: 10.4103/ijo.ijo_1927_22] [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] [Indexed: 11/05/2022] Open
Abstract
A 13-year-old boy developed painless diminution of vision in left eye 15 days after taking first dose of coronavirus disease 2019 (COVID-19) vaccine (Corbevax). Fundus and fluorescein angiography revealed central retinal vein occlusion in the left eye. Blood investigations were noncontributory. He was administered three doses of pulse corticosteroids followed by a tapering dose of oral corticosteroids. Retinal vascular occlusion can occur following COVID-19 vaccination in children, and early and aggressive systemic anti-inflammatory therapy can be helpful.
Collapse
Affiliation(s)
- Purna Nangia
- Department of Vitreoretina, Medical Research Foundations, Sankara Nethralaya, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - V Jaya Prakash
- Department of Vitreoretina, Medical Research Foundations, Sankara Nethralaya, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Parthopratim Dutta Majumder
- Department of Uvea, Medical Research Foundations, Sankara Nethralaya, Sankara Nethralaya, Chennai, Tamil Nadu, India,Correspondence to: Dr. Parthopratim Dutta Majumder, Department of Uvea, Sankara Nethralaya, 18, College Road, Nungambakkam, Chennai – 600 006, India. E-mail:
| |
Collapse
|
17
|
Chen YC. Combined central retinal artery occlusion and vein occlusion with exudative retinal detachment following COVID-19 vaccination. Kaohsiung J Med Sci 2022; 38:1020-1021. [PMID: 36098473 PMCID: PMC9538132 DOI: 10.1002/kjm2.12591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/17/2022] [Accepted: 07/31/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Yen-Chih Chen
- Department of Ophthalmology, Yunlin Christian Hospital, Xiluo, Taiwan.,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan
| |
Collapse
|
18
|
Retinal Vascular Occlusion after COVID-19 Vaccination: More Coincidence than Causal Relationship? Data from a Retrospective Multicentre Study. J Clin Med 2022; 11:jcm11175101. [PMID: 36079030 PMCID: PMC9457026 DOI: 10.3390/jcm11175101] [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: 07/17/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background: To investigate whether vaccination against SARS-CoV-2 is associated with the onset of retinal vascular occlusive disease (RVOD). Methods: In this multicentre study, data from patients with central and branch retinal vein occlusion (CRVO and BRVO), central and branch retinal artery occlusion (CRAO and BRAO), and anterior ischaemic optic neuropathy (AION) were retrospectively collected during a 2-month index period (1 June–31 July 2021) according to a defined protocol. The relation to any previous vaccination was documented for the consecutive case series. Numbers of RVOD and COVID-19 vaccination were investigated in a case-by-case analysis. A case–control study using age- and sex-matched controls from the general population (study participants from the Gutenberg Health Study) and an adjusted conditional logistic regression analysis was conducted. Results: Four hundred and twenty-one subjects presenting during the index period (61 days) were enrolled: one hundred and twenty-one patients with CRVO, seventy-five with BRVO, fifty-six with CRAO, sixty-five with BRAO, and one hundred and four with AION. Three hundred and thirty-two (78.9%) patients had been vaccinated before the onset of RVOD. The vaccines given were BNT162b2/BioNTech/Pfizer (n = 221), followed by ChadOx1/AstraZeneca (n = 57), mRNA-1273/Moderna (n = 21), and Ad26.COV2.S/Johnson & Johnson (n = 11; unknown n = 22). Our case–control analysis integrating population-based data from the GHS yielded no evidence of an increased risk after COVID-19 vaccination (OR = 0.93; 95% CI: 0.60–1.45, p = 0.75) in connection with a vaccination within a 4-week window. Conclusions: To date, there has been no evidence of any association between SARS-CoV-2 vaccination and a higher RVOD risk.
Collapse
|
19
|
Dutta Majumder P, Prakash VJ. Retinal venous occlusion following COVID-19 vaccination: Report of a case after third dose and review of the literature. Indian J Ophthalmol 2022; 70:2191-2194. [PMID: 35648014 PMCID: PMC9359265 DOI: 10.4103/ijo.ijo_592_22] [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] [Indexed: 11/05/2022] Open
Abstract
A 28-year-old, healthy male presented with blurring of vision in the right eye following third dose of the AstraZeneca/COVISHIELD vaccine. Further examination revealed ischemic central retinal vein occlusion, and subsequent laboratory investigations were inconclusive for his eye disease. He responded to pulse corticosteroid and tapering doses of oral corticosteroids without requiring any intra-vitreal injection. Twelve articles were identified with the help of a PubMed literature search, and a short review of these patients was performed. Retinal vein occlusion can occur because of inflammation-induced thrombosis after coronavirus disease 2019 vaccination and may respond to anti-inflammatory therapy.
Collapse
Affiliation(s)
| | - Vadivelu Jaya Prakash
- Department of Vitreoretina, Medical and Vision Research Foundations, Sankara Nethralaya, Sankara Nethralaya, Chennai, Tamil Nadu, India
| |
Collapse
|
20
|
Pur DR, Catherine Danielle Bursztyn LL, Iordanous Y. Branch retinal vein occlusion in a healthy young man following mRNA COVID-19 vaccination. Am J Ophthalmol Case Rep 2022; 26:101445. [PMID: 35211659 PMCID: PMC8855639 DOI: 10.1016/j.ajoc.2022.101445] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose To report a case of a branch retinal vein occlusion (BRVO) following mRNA COVID-19 vaccination. Observations A 34-year-old healthy male presented with blurriness in the inferior visual field, intermittent photopsia, multiple retinal hemorrhages, dilated and tortuous retinal vessels, and cotton wools spots in the right eye. The clinical examination and ancillary tests confirmed the diagnosis of a right eye BRVO. The visual symptoms started 2 days following first dose COVID-19 vaccination with the BNT162b2 (Pfizer-BioNTech) mRNA vaccine. Conclusions and importance This is a rare case of BRVO in an otherwise healthy young man, presenting after vaccination for COVID-19 in the absence of other coagulable risk factors. As the literature on venous thrombosis after COVID-19 vaccinations remains sparse, it is critical to raise awareness that BRVO could be a vaccine-related thrombotic adverse event. We highlight that as more of the population is vaccinated, an increased incidence of BRVO may confirm the link to COVID-19 vaccination.
Collapse
|
21
|
Finsterer J. Retinal artery/vein occlusion complicating SARS-CoV-2 vaccinations. J Stroke Cerebrovasc Dis 2022; 31:106617. [PMID: 35786536 PMCID: PMC9234003 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/23/2022] [Indexed: 11/12/2022] Open
|
22
|
Vujosevic S, Limoli C, Romano S, Vitale L, Villani E, Nucci P. Retinal vascular occlusion and SARS-CoV-2 vaccination. Graefes Arch Clin Exp Ophthalmol 2022; 260:3455-3464. [PMID: 35612613 PMCID: PMC9130976 DOI: 10.1007/s00417-022-05707-5] [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: 02/10/2022] [Revised: 04/26/2022] [Accepted: 05/14/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To assess the clinical and retinal imaging features of patients in whom retinal vascular occlusion (VO) had developed in temporal associations with COVID-19 vaccination. METHODS In this retrospective case series, all consecutive adult patients with new onset VO within 6 weeks of vaccination against COVID-19 were included in the study between May 1 and October 31, 2021. All patients had a systemic medical health assessment, full ophthalmic evaluation, and complete fundus imaging. RESULTS Fifteen eyes of VO (14 patients) after COVID-19 vaccinations were identified. The median time between vaccination and symptoms onset was 14 days (range 7-42 days). The mean best-corrected visual acuity (BCVA) was 20/55 with a range of 20/20 to 20/200. Eleven of 15 eyes (73.3%) had visual acuity improvement after intravitreal treatment at 60-90 days (range, 45-105 days) from the presentation. Four of 5 cases without systemic risk factors for VO had a mean BCVA > 20/32 at presentation and > 20/25 at the latest evaluation. Between May 1 and October 31, 2021, a temporal association was found between the 15 reported cases and COVID-19 vaccination out of a total of 29 VO (p = 0.05). The incidence of VO was higher in the considered period compared to the equivalent 6-month period in 2019 (1.17% vs 0.52%, respectively; p = 0.0134). CONCLUSIONS Retinal vascular occlusion with different grades of severity are reported in temporal association with COVID-19 vaccination. The exact pathogenic mechanism needs to be further studied. No certain causal relationship can be established from this case series.
Collapse
Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy. .,Eye Clinic, IRCCS MultiMedica, Milan, Italy.
| | - Celeste Limoli
- Eye Clinic, IRCCS MultiMedica, Milan, Italy.,University of Milan, Milan, Italy
| | | | | | - Edoardo Villani
- Eye Clinic, IRCCS MultiMedica, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| |
Collapse
|
23
|
Momenaei B, Cheraqpour K, Soleimani M, Tabatabaei SA, Shahriari M, Etesali H, Hussein A, Vaseghi Y, Ramezani B, Djalilian AR. Ophthalmic side effects of COVID-19 vaccines. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2066523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bita Momenaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Seyed Ali Tabatabaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoor Shahriari
- Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Etesali
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmed Hussein
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Vaseghi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Ramezani
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
24
|
Roncati L, Manenti A, Corsi L. A Three-Case Series of Thrombotic Deaths in Patients over 50 with Comorbidities Temporally after modRNA COVID-19 Vaccination. Pathogens 2022; 11:pathogens11040435. [PMID: 35456110 PMCID: PMC9032304 DOI: 10.3390/pathogens11040435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 01/04/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is the most dramatic pandemic of the new millennium; to counteract it, specific vaccines have been launched in record time under emergency use authorization or conditional marketing authorization by virtue of a favorable risk/benefit balance. Among the various technological platforms, there is that exploiting a nucleoside-modified messenger RNA (modRNA), such as Comirnaty®, and that which is adenoviral vector-based. In the ongoing pharmacovigilance, the product information of the latter has been updated about the risk of thrombotic thrombocytopenia, venous thromboembolism without thrombocytopenia and immune thrombocytopenia without thrombosis. However, from an in-depth literature review, the same adverse events can rarely occur with modRNA vaccines too. In support of this, we here report a three-case series of thrombotic deaths in patients over 50 with comorbidities temporally after Comirnaty®, investigated by means of post-mortem histopathology and immunohistochemistry. In two out of three cases, the cause of death is traced back to pulmonary microthromboses rich in activated platelets, quite similar morphologically to those described in patients who died from severe COVID-19. Even if remote in the face of millions of administered doses, clinicians should be aware of the possible thrombotic risk also after Comirnaty®, in order to avoid a misdiagnosis with potentially lethal consequences. Since COVID-19 vaccines are inoculated in subjects to be protected, maximum attention must be paid to their safety, and prophylactic measures to increase it are always welcome. In light of the evidence, the product information of modRNA COVID-19 vaccines should be updated about the thrombotic risk, as happened for adenoviral vector-based vaccines.
Collapse
Affiliation(s)
- Luca Roncati
- Institute of Pathology, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Correspondence: or or
| | - Antonio Manenti
- Unit of Surgery, Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Lorenzo Corsi
- Department of Life Sciences, Section of Pharmacology, University of Modena and Reggio Emilia, 41125 Modena, Italy;
- National Institute of Biostructures and Biosystems, Inter-University Consortium, 00136 Rome, Italy
| |
Collapse
|
25
|
Abrignani MG, Murrone A, De Luca L, Roncon L, Di Lenarda A, Valente S, Caldarola P, Riccio C, Oliva F, Gulizia MM, Gabrielli D, Colivicchi F. COVID-19, Vaccines, and Thrombotic Events: A Narrative Review. J Clin Med 2022; 11:948. [PMID: 35207220 PMCID: PMC8880092 DOI: 10.3390/jcm11040948] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 02/05/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), a deadly pandemic that has affected millions of people worldwide, is associated with cardiovascular complications, including venous and arterial thromboembolic events. Viral spike proteins, in fact, may promote the release of prothrombotic and inflammatory mediators. Vaccines, coding for the spike protein, are the primary means for preventing COVID-19. However, some unexpected thrombotic events at unusual sites, most frequently located in the cerebral venous sinus but also splanchnic, with associated thrombocytopenia, have emerged in subjects who received adenovirus-based vaccines, especially in fertile women. This clinical entity was soon recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia, probably caused by cross-reacting anti-platelet factor-4 antibodies activating platelets. For this reason, the regulatory agencies of various countries restricted the use of adenovirus-based vaccines to some age groups. The prevailing opinion of most experts, however, is that the risk of developing COVID-19, including thrombotic complications, clearly outweighs this potential risk. This point-of-view aims at providing a narrative review of epidemiological issues, clinical data, and pathogenetic hypotheses of thrombosis linked to both COVID-19 and its vaccines, helping medical practitioners to offer up-to-date and evidence-based counseling to their often-alarmed patients with acute or chronic cardiovascular thrombotic events.
Collapse
Affiliation(s)
| | - Adriano Murrone
- Cardiology-UTIC, Hospitals of Città di Castello and Gubbio-Gualdo Tadino, AUSL Umbria 1, 06100 Perugia, Italy;
| | - Leonardo De Luca
- Cardiology, Cardio-Thoraco-Vascular Department, San Camillo Forlanini Hospital, 00100 Rome, Italy; (L.D.L.); (D.G.)
| | - Loris Roncon
- Cardiology Department, Santa Maria della Misericordia Hospital, 45100 Rovigo, Italy;
| | - Andrea Di Lenarda
- Cardiovascular and Sports Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, 34100 Trieste, Italy;
| | - Serafina Valente
- Clinical Surgical Cardiology (UTIC), A.O.U. Senese, Santa Maria alle Scotte Hospital, 53100 Siena, Italy;
| | | | - Carmine Riccio
- Follow-Up of the Post-Acute Patient Unit, Cardio-Vascular Department, A.O.R.N. Sant’Anna and San Sebastiano, 81000 Caserta, Italy;
| | - Fabrizio Oliva
- Cardiology 1-Hemodynamics, Cardiological Intensive Care Unit, Cardiothoracovascular Department “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, 20100 Milan, Italy;
| | - Michele M. Gulizia
- Cardiology Department, Garibaldi-Nesima Hospital, Company of National Importance and High Specialization “Garibaldi”, 95100 Catania, Italy;
- Heart Care Foundation, 50121 Florence, Italy
| | - Domenico Gabrielli
- Cardiology, Cardio-Thoraco-Vascular Department, San Camillo Forlanini Hospital, 00100 Rome, Italy; (L.D.L.); (D.G.)
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri—ASL Roma 1, 00100 Rome, Italy;
| | | |
Collapse
|