Paracentral Acute Middle Maculopathy Associated With Cilioretinal Artery Insufficiency Following COVID-19 Vaccination in a Young Patient

Abstract

We aim to present a unique case of unilateral paracentral acute middle maculopathy (PAMM) associated with cilioretinal artery insufficiency following the coronavirus disease 2019 (COVID-19) vaccination. A 28year-old male complained of a sudden blurring of vision in his left eye 40 days after receiving the second dose of COVID-19 immunization. The optical coherence tomography revealed a diffuse paracentral area of hyper-reflective change in the inner plexiform layer and an increase in the inner nuclear layer volume, consistent with PAMM along the course of the cilioretinal artery. PAMM has been connected to an assortment of retinal vasculature anomalies. Considering COVID-19 vaccination, we hypothesize that the immunogenic cascade following vaccination dysregulated coagulation and led to retinal vascular thrombosis. However, the link between COVID-19 vaccination and retinal vascular occlusion disease remains unknown.

Retinal Vascular Occlusion after Severe Acute Respiratory Syndrome Coronavirus Vaccination

“…The published literature assessing the association between retinal vessel occlusion and SARS-CoV-2 vaccination is limited to case reports, series, and review articles. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , Although the evidence in the literature speculated a causal association between the adenoviral vector and mRNA-based SARS-CoV-2 vaccines, the precise mechanism is not completely understood. An immunologic basis has been hypothesized, ultimately leading to the activation of platelets causing dysregulated coagulation.…”