Multiple evanescent white dot syndrome following vaccination for COVID-19

Abstract

Rationale: Multiple evanescent white dot syndrome (MEWDS) is an acute, usually unilateral, retinal disorder of unknown etiology that predominantly occurs in healthy young women. We report a case of bilateral asymmetric MEWDS that developed following the first vaccination for coronavirus-19 and worsened after a second vaccination. Patient concerns: A 30-year-old Japanese woman was examined in an eye clinic for blurred vision in her left eye for 1 week duration. Thirteen days before her examination, she had received her first BNT162b2 mRNA SARS-CoV-2 vaccination. Her best-corrected visual acuity was 20/20 in both eyes. Fundus examination revealed multiple yellowish-white spots in the perifoveal area of both eyes. Visibility of the spots gradually decreased during the following week. She was then vaccinated with a second dose, and 3 days later, her vision worsened in her left eye. She was then referred to our hospital because of worsened vision and the appearance of white spots on other parts of the retina. Ophthalmological examination revealed a best-corrected visual acuity of 30/20 both eyes. Diagnosis: The flare value in the anterior chamber was elevated in both the eyes. Fundus examination showed multiple white spots in the perifoveal area of both eyes, but they were more prominent in the left eye. Fundus fluorescein angiography revealed early hyperfluorescent spots located circumferentially around the fovea in both eyes. We concluded that the patient had MEWDS, which was most likely due to mRNA COVID-19 immunization. Interventions: The patient was treated with topical betamethasone sodium phosphate/fradiomycin sulfate 0.1% thrice daily for 2 months. Outcomes: Two months after treatment, her blurry vision resolved with the disappearance of the fundus lesions. Lesson: Clinicians should be aware of potential adverse ocular events following similar vaccinations.

Multiple evanescent white dot syndrome following BNT162b2 mRNA COVID-19 vaccination

“… 9 Among them, acute idiopathic maculopathy, acute macular neuroretinopathy (AMN), and Vogt-Koyanagi-Harada disease (VKH) besides MEWDS have been reported as posterior ocular manifestation. 7 , 10 , 11 , 12 , 13 , 14 , 15 …”

“…The mRNA vaccine-induced IFN-I through RNA sensors including RIG-I promotes differentiation of CD4 + and CD8 + effector T cells associated with inflammatory and cytotoxic mediators, and CD4 + helper T cells promoting B cell differentiation into plasma cells with the ability of antibody-secretion. 7 , 11 …”

Ocular Adverse Events after Inactivated COVID-19 Vaccination

“…It is assumed that it is due to an immunemediated mechanism manifested in either the outer retina, choriocapillaris/inner choroid, or both, in genetically predisposed individuals [15]. In addition to after vaccination with an inactivated COVID-19 vaccine, MEWDS has also been reported to occur after various vaccinations, including the mRNA COVID-19 vaccine [16], as well as, influenza [15], rabies [17], human papilloma virus [18], hepatitis A and B [19,20], meningococcal [21], and yellow fever vaccines [19]. Specifically, vaccines have been suggested to trigger an inflammatory response resulting in uveitis by means of molecular mimicry or direct antigen-mediated cellular/humoral immune response, or adjuvant-mediated inflammation [22,23].…”

Punctate inner choroidopathy immediately after COVID-19 infection: a case report

“…Acute macular neuroretinopathy occurred in a 71-year-old woman 14 days after COVID-19 infection [ 7 ] and in a 27-year-old woman two days after administration of the COVID-19 vaccine [ 8 ]. Furthermore, multiple evanescent white dot syndrome occurred in a 17-year-old man two months and ten days after COVID-19 infection [ 9 ] and in a 30-year-old woman three days after the second dose of the COVID-19 vaccine [ 10 ]. Serpiginous choroiditis occurred in a 41-year-old woman after COVID-19 infection [ 11 ].…”