COVID-19 Recombinant mRNA Vaccines and Serious Ocular Inflammatory Side Effects: Real or Coincidence?

Abstract

Purpose: To report two cases; bilateral arteritic anterior ischemic optic neuropathy (AAION) and bilateral acute zonal occult outer retinopathy (AZOOR) after COVID-19 mRNA vaccination.
 Case Reports: The first patient was a 79-year-old female was presented to us 35 days after a sudden bilateral loss of vision, which occurred two days after receiving the second recombinant mRNA vaccine (Pfizer) injection. Temporal artery biopsy was compatible with AAION. At presentation, the best-corrected visual acuity was 20/1250 and 20/40 in the right and left eyes on the Snellen acuity chart, respectively. There was 3+ afferent pupillary defect in the right eye. The anterior segment and posterior segment exams were normal except for pallor of the optic nerve head in both eyes. Intraocular pressure was normal in both eyes. She was diagnosed with bilateral AAION and Subcutaneous tocilizumab 162 mg weekly was recommended with monitoring her ESR, CRP, and IL-6. The second patient was a 33-year-old healthy female who was referred to us for a progressive nasal field defect in her left eye, and for flashes in both eyes. Her symptoms started 10 days after receiving the second recombinant mRNA vaccine (Moderna) injection. Complete bloodwork performed by a uveitis specialist demonstrated high ESR (25) and CRP (19) levels. As a result, she was diagnosed with unilateral AZOOR in her left eye and was subsequently treated with an intravitreal dexamethasone implant in the same eye. At presentation, vision was20/20 in both eyes. The anterior segment and posterior segment exams were completely normal except for the presence of abnormal white reflex in the temporal macula of her left eye. We diagnosed her with bilateral AZOOR. Since she was nursing, intravitreal dexamethasone implant was recommended for the right eye.
 Conclusion: There may be a correlation between ocular inflammatory diseases with autoimmune mechanism and the mRNA COVID-19 vaccination.

Nonarteritic Anterior Ischemic Optic Neuropathy following COVID-19 Vaccination: Consequence or Coincidence

“…In contrast, various adverse effects have been reported with COVID-19 vaccine [ 2 , 3 ], but these events' specific mechanism and frequency have not been investigated thoroughly. A previous case of arteritic anterior ischemic optic neuropathy following COVID-19 vaccination was reported [ 10 ]; however, this is the first reported case of NA-AION which was temporally related to the COVID-19 vaccination in Japan.…”

“…COVID-19 vaccines result in producing high levels of neutralizing antibodies after injection. These neutralizing antibodies recognize and target the spike proteins in the virus, killing it before the virus is disseminated and cause illness [ 10 ]. Neutralizing antibodies against SARS-CoV-2 spike proteins and/or activated T-helper-1 cells after vaccination can crossreact with proteins and antigens in large arteries, outer retinal layers, and retinal pigment epithelial cell [ 10 ].…”

“…These neutralizing antibodies recognize and target the spike proteins in the virus, killing it before the virus is disseminated and cause illness [ 10 ]. Neutralizing antibodies against SARS-CoV-2 spike proteins and/or activated T-helper-1 cells after vaccination can crossreact with proteins and antigens in large arteries, outer retinal layers, and retinal pigment epithelial cell [ 10 ]. Although it is uncertain whether the development of NA-AION after COVID-19 vaccination was consequential or coincidental, we speculate that the close temporal relationship with COVID-19 vaccination suggests the possibility of vasculopathy on the microvascular network of optic nerve head as background of inflammatory or immune-mediated element to the timing of the onset of NA-AION.…”

Adverse Ocular Events following COVID-19 Vaccination

“…Table 1 summarizes our review of literature from 16 publications reporting on 20 patients with ocular complications following COVID-19 vaccinations. In brief, these included graft rejections [ 34 – 38 31 ], macular neuroretinopathy [ 39 – 41 ], multifocal choroiditis [ 42 , 43 ], acute uveitis [, 32 , 44 , 45 ], central serous retinopathy [ 33 ], arteritic anterior ischemic optic neuropathy [ 46 ], and acute zonal occult outer retinopathy [ 46 ].…”

“…In brief, these included graft rejections [ 34 – 38 31 ], macular neuroretinopathy [ 39 – 41 ], multifocal choroiditis [ 42 , 43 ], acute uveitis [, 32 , 44 , 45 ], central serous retinopathy [ 33 ], arteritic anterior ischemic optic neuropathy [ 46 ], and acute zonal occult outer retinopathy [ 46 ].…”