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

Abstract

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

Graft rejection in component keratoplasty

“…[ 100 ] The interval between vaccination and graft rejection is reported to range from 1 day to 6 weeks. [ 101 ] Rejection has been reported following BNT162b2 (Pfizer), mRNA-1273 (Moderna), ChAdOx1 (AstraZeneca), and CoronaVac (Sinovac) vaccines. [ 101 ] Vaccines are known to boost cell-mediated immune responses.…”

“…[ 101 ] Rejection has been reported following BNT162b2 (Pfizer), mRNA-1273 (Moderna), ChAdOx1 (AstraZeneca), and CoronaVac (Sinovac) vaccines. [ 101 ] Vaccines are known to boost cell-mediated immune responses. It is possible that the resultant increase in CD4+ T-cell responses causes acute rejection following vaccination.…”

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

“…Organ-specific adverse events are largely limited to case series and case reports. Case reports and retrospective case series have described possible associations between the administration of the SARS-CoV-2 vaccine and the onset of ophthalmic complications involving the eyelid, orbit, cornea, retina, and other ocular structures [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. There are numerous reports of corneal complications in particular.…”

Incidence of Graft Rejection in Descemet Membrane Endothelial Keratoplasty After COVID-19 mRNA Vaccination

“…However, some cases of rejection have been reported after the global outbreak of COVID-19, which questions the stable outcomes of the procedure. 3,4…”

“…However, some cases of rejection have been reported after the global outbreak of COVID-19, which questions the stable outcomes of the procedure. 3,4 Despite its prophylactic effects, this vaccine has been reported to have systemic side effects, including myocarditis, Guillain-Barré syndrome, and autoimmune myositis. [5][6][7] Adverse ocular effects, such as acute anterior uveitis, anterior scleritis, and conjunctivitis, [8][9][10] have also been reported.…”