Retinal Vascular Events after mRNA and Adenoviral-Vectored COVID-19 Vaccines—A Case Series

Abstract

Background: To describe cases of retinal vascular events shortly after administration of mRNA or adenoviral-vectored COVID-19 vaccines. Design: Retrospective, multicenter case series. Methods: Six cases of retinal vascular events shortly after receiving COVID-19 vaccines. Results: A 38-year-old, otherwise healthy male patient presented with branch retinal arterial occlusion four days after receiving his second dose of SARS-CoV-2 vaccination with Comirnaty® (BioNTech®, Mainz, Germany; Pfizer®, New York City, NY, USA). An 81-year-old female patient developed visual symptoms twelve days after the second dose of SARS-CoV-2 vaccination with Comirnaty® and was diagnosed with a combined arterial and venous occlusion in her right eye. A 40-year-old male patient noticed blurry vision five days after his first dose of SARS-CoV-2 vaccination with Comirnaty® and was diagnosed with venous stasis retinopathy in his left eye. A 67-year-old male was diagnosed with non-arteritic anterior ischemic optic neuropathy in his right eye four days after receiving the first dose of Vaxzevria® (AstraZeneca®, Cambridge, UK). A 32-year-old man presented with a sudden onset of a scotoma two days after receiving the second dose of SARS-CoV-2 vaccination with Spikevax® (Moderna, Cambridge, UK) and was diagnosed with a circumscribed nerve fiber infarction. A 21-year-old female patient developed an acute bilateral acute macular neuroretinopathy three days after receiving the first dose of SARS-CoV2-vaccine Vaxzevria® (AstraZeneca®, Cambridge, UK). Conclusion: This case series describes six cases of retinal vascular events shortly after receiving mRNA or adenoviral-vectored COVID-19 vaccines. The short time span between received vaccination and occurrence of the observed retinal vascular events raises the question of a direct correlation. Our case series adds to further reports of possible side effects with potential serious post-immunization complications of COVID-19 vaccinations.

Case Report: Recanalization of Branch Retinal Artery Occlusion Due to Microthrombi Following the First Dose of SARS-CoV-2 mRNA Vaccination

“…Three cases of RAO that arose 2–12 days after SARS-CoV-2 mRNA vaccination have been reported recently. However, the changes and outcomes of visual acuity and field were not discussed ( Girbardt et al, 2021 ; Ikegami et al, 2021 ). In one case, BRAO occurred in a 39-year-old man 4 days after the second dose of the BNT162b2 vaccine without thrombocytopenia ( Girbardt et al, 2021 ).…”

“…However, the changes and outcomes of visual acuity and field were not discussed ( Girbardt et al, 2021 ; Ikegami et al, 2021 ). In one case, BRAO occurred in a 39-year-old man 4 days after the second dose of the BNT162b2 vaccine without thrombocytopenia ( Girbardt et al, 2021 ). Two additional cases combined with RAO and RVO were presented after the second dose of the mRNA-1273 and BNT162b2 vaccines ( Girbardt et al, 2021 ; Ikegami et al, 2021 ).…”

“…In one case, BRAO occurred in a 39-year-old man 4 days after the second dose of the BNT162b2 vaccine without thrombocytopenia ( Girbardt et al, 2021 ). Two additional cases combined with RAO and RVO were presented after the second dose of the mRNA-1273 and BNT162b2 vaccines ( Girbardt et al, 2021 ; Ikegami et al, 2021 ). The common features of these RAO cases, along with this case, were non-embolic RAO, not accompanied by carotid plaque or stenosis, mRNA of SARS-CoV-2 vaccine, and rapid development within 2 weeks after vaccination.…”

Ischemic retinal events after COVID-19 vaccination

“… Vaccine Onset of Symptoms After Vaccine September 1, 2021 17 AMN (bilateral) 20 Female Vaginal hormonal contraception Pfizer 2 days September 23, 2021 18 AMN (bilateral) 23 Female Oral contraception AstraZeneca 1 day November 17, 2021 19 AMN (bilateral) 21 Female No AstraZeneca 3 days January 1, 2022 20 AMN (unilateral) 22 Female No AstraZeneca 5 days January 1, 2022 21 AMN (bilateral) 26 Female Oral contraception Johnson & Johnson 2 days January 20, 2022 22 AMN (bilateral) 25 Female Oral contraception AstraZeneca 1 day January 20, 2022 23 AMN (bilateral) 31 Female Oral contraceptive AstraZeneca 2 days January 20, 2022 23 AMN (bilateral) 19 Female...…”

Retinal Hemorrhage after SARS-CoV-2 Vaccination

“…This increases the need for ophthalmological studies on vaccine-related side-effects, where SARS-CoV-2 vaccination may become annual. Known intraocular side-effects include acute macular neuroretinopathy, central serous chorioretinopathy, reactivation of Vogt-Koyanagi-Harada disease, panuveitis, Descemet’s membrane endothelial keratoplasty (DMEK) graft rejection, retinal hemorrhage and vascular events including retinal arterial occlusion and retinal vein occlusion (RVO) [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Here, we present a unique case series of RVO, and age-related macular degeneration (AMD) exhibiting submacular hemorrhage, temporally related to administration of SARS-CoV-2 vaccines.…”