Keratoplasty Rejection After the BNT162b2 messenger RNA Vaccine

Abstract

Purpose: The aim of this report was to report 2 patients who presented with acute corneal graft rejection 2 weeks after receiving the BNT162b2 messenger RNA (mRNA) vaccine for severe acute respiratory syndrome coronavirus 2. Methods: Case report. Results: Two men, aged 73 and 56 years, with a history of penetrating keratoplasty due to keratoconus were noted to have acute corneal graft rejection 2 weeks after receiving a first dose of the BNT162b2 mRNA vaccine. Both patients were treated with hourly dexamethasone 0.1% and oral prednisone 60 mg per day with prompt resolution of keratoplasty rejection. Conclusions: The BNT162b2 mRNA vaccine may be have been associated with a low-risk corneal graft rejection that responded well to topical and systemic steroids. Treating physicians should be aware of this potential complication and patients should be advised to report any visual changes after vaccination.

Ocular Adverse Events After COVID-19 Vaccination

“… A case report of Graves’ disease activation post-vaccination BNT162b2 1 2–3 days n = 2 Wasser et al . 43 Keratoplasty Rejection After the BNT162b2 messenger RNA Vaccine. A case report of penetrating keratoplasty (PKP) patients with graft rejection post-vaccination BNT162b2 1 13–14 days Blurred vision, ocular discomfort, red eye n = 2 …”

“…Four articles described corneal graft rejection soon after receiving a COVID-19 vaccination. 25 , 34 , 36 , 43 Phylactou et al . 34 reported two cases of allograft rejection following Descemet’s membrane endothelial keratoplasty (DMEK); both were female.…”

“…The graft remained clear, and visual acuity remained stable 3 weeks after the second dose. Rejections were also reported following three penetrating keratoplasty (PKP) cases 36 , 43 ; all three were male; 1 case had a previous re-graft. Two of the PKP rejections manifested 13 to 14 days after receiving the first dose 43 of the vaccine, while the third occurred after 21 days, also from the first dose.…”

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 ].…”