Development of Branch Retinal Vein Occlusion Following COVID-19 Vaccination and Subsequent SARS-CoV-2 Infection While Taking Oral Contraceptives

Abstract

Objectives Oral contraceptive use, vaccination for coronavirus disease 2019 (COVID-19), and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are all risk factors for venous thromboembolism (VTE). Although, in general, branch retinal vein occlusion (BRVO) develops during the mid-60s in general, we present a case of BRVO caused by the abovementioned risk factors in a young woman. To the best of our knowledge, this is the first report about BRVO associated with oral contraceptives, COVID-19 vaccination, and SARS-CoV-2. Case presentation: A 21-year-old woman was referred to us after experiencing loss of visual acuity in her right eye from 10 days ago. She had been using oral contraceptives for 2 years for paramenia before noticing her ophthalmological symptoms. Despite having received two does of the mRNA COVID-19 vaccine, she had contracted COVID-19 with fever, sore throat, cough, low back pain, and general malaise about 40 days before the initial visit. However, only the cough persisted for a month. The right eye showed BRVO with macular edema (ME). She did not smoke or have diabetes mellitus or systemic hypertension. The result of blood test was normal, including the cardiolipin antibody IgG. She was treated with an intravitreal aflibercept injection immediately. The right fundus showed rapid improvement in the resolution of ME. Conclusions The combination of oral contraceptive use, COVID-19 vaccination, and subsequent SARS-CoV-2 infection could accelerate VTE, thereby leading to BRVO. Given that cases of COVID-19 have increased globally, patients with RVO who use oral contraceptives are likely to be encountered more frequently.