Combined central retinal artery and vein occlusion shortly after mRNA-SARS-CoV-2 vaccination

Ikegami, Yasuko; Numaga, Jiro; Okano, Natsumi; Fukuda, Shoko; Yamamoto, Hiroki; Terada, Yukiko

doi:10.1093/qjmed/hcab287

Cited by 34 publications

(32 citation statements)

References 6 publications

(5 reference statements)

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“…However, there is now a growing literature reporting single case reports with RVO after both mRNA vaccines including mRNA-1273 (Moderna) [ 12 ] and BNT162b2 (Pfizer) [ 13 – 16 ], and vector-based ChAdOx1 (Vaxzevria) [ 17 – 19 ]. Other single case reports have documented combined CRAO-CRVO shortly after mRNA-1273 (Moderna) [ 20 ], combined CRAO-CRVO with ischemic optic neuropathy after BNT162b2 (Pfizer) [ 21 ], and CRAO after ChAdOx1 (Vaxzevria) [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Retinal vascular occlusion and SARS-CoV-2 vaccination

Vujosevic

Limoli

Romano

et al. 2022

Graefes Arch Clin Exp Ophthalmol

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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.

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Section: Discussionmentioning

confidence: 99%

Retinal vascular occlusion and SARS-CoV-2 vaccination

Vujosevic

Limoli

Romano

et al. 2022

Graefes Arch Clin Exp Ophthalmol

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“…Three cases of RAO that arose 2–12 days after SARS-CoV-2 mRNA vaccination have been reported recently. However, the changes and outcomes of visual acuity and field were not discussed ( Girbardt et al, 2021 ; Ikegami et al, 2021 ). In one case, BRAO occurred in a 39-year-old man 4 days after the second dose of the BNT162b2 vaccine without thrombocytopenia ( Girbardt et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…In one case, BRAO occurred in a 39-year-old man 4 days after the second dose of the BNT162b2 vaccine without thrombocytopenia ( Girbardt et al, 2021 ). Two additional cases combined with RAO and RVO were presented after the second dose of the mRNA-1273 and BNT162b2 vaccines ( Girbardt et al, 2021 ; Ikegami et al, 2021 ). The common features of these RAO cases, along with this case, were non-embolic RAO, not accompanied by carotid plaque or stenosis, mRNA of SARS-CoV-2 vaccine, and rapid development within 2 weeks after vaccination.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Recanalization of Branch Retinal Artery Occlusion Due to Microthrombi Following the First Dose of SARS-CoV-2 mRNA Vaccination

2022

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Background: We report on a patient with a branch retinal artery occlusion (RAO) and its recanalization based on multimodal retinal and angiographic images after he was administered the first dose of the SARS-CoV-2 mRNA vaccine.Case summary: A 64-year-old man complained of a right, painless, inferior field defect 3 days after the first dose of BNT162b2 vaccination. Fundus examination revealed decolorization of the right upper macula, including microthrombi in the superior proximal branch of the retinal artery. Optical coherence tomography angiography revealed upper macular hypoperfusion. Fluorescein angiography revealed prolonged arteriovenous transit to the macula. After paracentesis with antiplatelet medications, the artery was recanalized as the thrombi dissolved, and the right visual field was recovered. Re-occlusion did not occur during the 3 months after the second mRNA vaccination.Conclusion: Non-embolic thrombotic RAO may develop shortly after the SARS-CoV-2 mRNA vaccine. Ophthalmologists should consider RAO as a possible post-vaccination adverse event. The temporal association between mRNA vaccination and RAO onset with evidence of microthrombi might provide additional clues to elucidate the unpredictive arterial thrombosis following SARS-CoV-2 mRNA vaccination.

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“…A 54-year-old female was referred to an ophthalmology clinic 8 days after her second dose of mRNA-1273, and was diagnosed with combined central retinal artery occlusion and CRVO. She felt the symptoms 2 days after the day of vaccination, and her vision was that of no light perception at presentation [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…This increases the need for ophthalmological studies on vaccine-related side-effects, where SARS-CoV-2 vaccination may become annual. Known intraocular side-effects include acute macular neuroretinopathy, central serous chorioretinopathy, reactivation of Vogt-Koyanagi-Harada disease, panuveitis, Descemet’s membrane endothelial keratoplasty (DMEK) graft rejection, retinal hemorrhage and vascular events including retinal arterial occlusion and retinal vein occlusion (RVO) [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Here, we present a unique case series of RVO, and age-related macular degeneration (AMD) exhibiting submacular hemorrhage, temporally related to administration of SARS-CoV-2 vaccines.…”

Section: Introductionmentioning

confidence: 99%

Retinal Hemorrhage after SARS-CoV-2 Vaccination

Park

Byun²,

Byeon

et al. 2021

JCM

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To report retinal vein occlusion (RVO) and age-related macular degeneration (AMD)-related submacular hemorrhage developing after administration of SARS-CoV-2 vaccines, a single-center, retrospective observational case series was conducted. Clinical data including fundus photographs and optical coherence tomography (OCT) scans were reviewed. Twenty-three eyes of 21 patients were included with the median age at symptom presentation being 77 years (range: 51–85 years). Twelve eyes (52.2%) had submacular hemorrhage and 11 (47.8%) had RVO. Twelve patients (60.9%) had been vaccinated with the Pfizer vaccine (BNT162b2) and 8 with the AstraZeneca (ChAdOx1) vaccine. Sixteen patients (76.2%) experienced ocular disease exacerbation after the first vaccination and 4 (19.0%) after the second vaccination. The median visual acuity (logarithm of the minimal angle of resolution; logMAR) before symptom development was 0.76 (interquartile range: 0.27–1.23); the median logMAR at symptom presentation was 1.40 (interquartile range 0.52–1.70). The median time between vaccination and symptom exacerbation was 2.0 days (interquartile range: 1.0–3.0 days). Five patients (23.8%) underwent tests for hematological abnormalities, including the presence of anti-PF4 antibodies; all were negative. Further studies with larger patient group for evaluation of effect of SARS-CoV-2 vaccination on retinal hemorrhage are necessary.

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Combined central retinal artery and vein occlusion shortly after mRNA-SARS-CoV-2 vaccination

Cited by 34 publications

References 6 publications

Retinal vascular occlusion and SARS-CoV-2 vaccination

Retinal vascular occlusion and SARS-CoV-2 vaccination

Case Report: Recanalization of Branch Retinal Artery Occlusion Due to Microthrombi Following the First Dose of SARS-CoV-2 mRNA Vaccination

Retinal Hemorrhage after SARS-CoV-2 Vaccination

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