Retinal Vascular Occlusion after COVID-19 Vaccination: More Coincidence than Causal Relationship? Data from a Retrospective Multicentre Study

Abstract

Background: To investigate whether vaccination against SARS-CoV-2 is associated with the onset of retinal vascular occlusive disease (RVOD). Methods: In this multicentre study, data from patients with central and branch retinal vein occlusion (CRVO and BRVO), central and branch retinal artery occlusion (CRAO and BRAO), and anterior ischaemic optic neuropathy (AION) were retrospectively collected during a 2-month index period (1 June–31 July 2021) according to a defined protocol. The relation to any previous vaccination was documented for the consecutive case series. Numbers of RVOD and COVID-19 vaccination were investigated in a case-by-case analysis. A case–control study using age- and sex-matched controls from the general population (study participants from the Gutenberg Health Study) and an adjusted conditional logistic regression analysis was conducted. Results: Four hundred and twenty-one subjects presenting during the index period (61 days) were enrolled: one hundred and twenty-one patients with CRVO, seventy-five with BRVO, fifty-six with CRAO, sixty-five with BRAO, and one hundred and four with AION. Three hundred and thirty-two (78.9%) patients had been vaccinated before the onset of RVOD. The vaccines given were BNT162b2/BioNTech/Pfizer (n = 221), followed by ChadOx1/AstraZeneca (n = 57), mRNA-1273/Moderna (n = 21), and Ad26.COV2.S/Johnson & Johnson (n = 11; unknown n = 22). Our case–control analysis integrating population-based data from the GHS yielded no evidence of an increased risk after COVID-19 vaccination (OR = 0.93; 95% CI: 0.60–1.45, p = 0.75) in connection with a vaccination within a 4-week window. Conclusions: To date, there has been no evidence of any association between SARS-CoV-2 vaccination and a higher RVOD risk.

Possible association between vaccination against SARS-CoV-2 and recurrence of macular edema due to branch retinal vein occlusion: a case report

“…Nevertheless, Feltgen et al. 15 reported that vaccination against SARS-CoV-2 was not associated with a higher risk of retinal vascular occlusive disease. Because our patient developed reduced vision 3 days after vaccination, we considered that vaccination might have been the cause of this phenomenon.…”

“…RVO is a multifactorial vascular disease characterized by retinal blood stasis, increased venous tortuosity, intraretinal hemorrhage, and macular edema (ME), and it may cause loss of vision or blindness. 12 Branch RVO (BRVO) occurs at arteriovenous crossing regions 15 and typically occurs in middle-aged and older patients (i.e., >50 years of age) with an equal sex distribution. ME is the main cause of vision loss in patients with BRVO.…”

Risk of New Retinal Vascular Occlusion After mRNA COVID-19 Vaccination Within Aggregated Electronic Health Record Data

“…Another large retrospective study examining cerebral vascular thrombosis after both mRNA and adenoviral COVID-19 vaccination found no association between vaccination and thrombosis for either formulation of COVID-19 vaccine. An examination of more than 500 patients presenting to retina clinics with RVO found many patients had been vaccinated against COVID-19, yet no association was observed between vaccination and RVO . Retinal vascular occlusion has been described and reviewed as an established sequela of COVID-19 infection itself due to microvasculopathy and inflammation-induced hypercoagulability .…”

“…An examination of more than 500 patients presenting to retina clinics with RVO found many patients had been vaccinated against COVID-19, yet no association was observed between vaccination and RVO. 21 Retinal vascular occlusion has been described and reviewed as an established sequela of COVID-19 infection itself due to microvasc ulopathy and inflammation-induced hypercoagulability. 22,23 Epidemiologic evidence for an association between mRNA COVID-19 vaccination and RVO remains scarce due to limited sample sizes in prior studies.…”

Big data are needed for analysis of the association of retinal vascular occlusion and COVID-19

“…No cohort studies have investigated the relationship of COVID-19 vaccination with retinal vascular occlusion. A recent multicenter study on COVID-19 vaccination reported no evidence for retinal vascular occlusion after vaccination, via age and sex-matched case–control analysis [ 5 ]. Otherwise, studies on COVID-19 vaccination and retinal vascular occlusion were mostly limited to case reports.…”