Risk assessment of retinal vascular occlusion after COVID-19 vaccination

Abstract

Coronavirus disease 2019 (COVID-19) vaccines are associated with several ocular manifestations. Emerging evidence has been reported; however, the causality between the two is debatable. We aimed to investigate the risk of retinal vascular occlusion after COVID-19 vaccination. This retrospective cohort study used the TriNetX global network and included individuals vaccinated with COVID-19 vaccines between January 2020 and December 2022. We excluded individuals with a history of retinal vascular occlusion or those who used any systemic medication that could potentially affect blood coagulation prior to vaccination. To compare the risk of retinal vascular occlusion, we employed multivariable-adjusted Cox proportional hazards models after performing a 1:1 propensity score matching between the vaccinated and unvaccinated cohorts. Individuals with COVID-19 vaccination had a higher risk of all forms of retinal vascular occlusion in 2 years after vaccination, with an overall hazard ratio of 2.19 (95% confidence interval 2.00–2.39). The cumulative incidence of retinal vascular occlusion was significantly higher in the vaccinated cohort compared to the unvaccinated cohort, 2 years and 12 weeks after vaccination. The risk of retinal vascular occlusion significantly increased during the first 2 weeks after vaccination and persisted for 12 weeks. Additionally, individuals with first and second dose of BNT162b2 and mRNA-1273 had significantly increased risk of retinal vascular occlusion 2 years following vaccination, while no disparity was detected between brand and dose of vaccines. This large multicenter study strengthens the findings of previous cases. Retinal vascular occlusion may not be a coincidental finding after COVID-19 vaccination.

Risk of New Retinal Vascular Occlusion After Messenger RNA COVID-19 Vaccination Within Aggregated Electronic Health Record Data—Reply

“…Li and colleagues’ conclusion is based on all types of COVID-19 vaccinations, not specifically mRNA vaccinations. However, they did report the risk of RVO, specifically with mRNA vaccinations, and found no association between vaccination and RVO development at 12 weeks, which agreed with our findings …”

“…In Reply We appreciate the letters regarding our article by Dorney et al in which messenger RNA (mRNA) COVID-19 vaccinations were not associated with retinal vascular occlusions (RVO). To summarize, the concerns with our study are in relation to Li and colleagues’ comparable article, our choice of a 21-day time frame and the association between first and second vaccination, evaluation of confounder variables, and control group selection.…”

“…Although cases have been reported after this time frame, this would have limited our ability to evaluate both vaccines separately. However, Li et al analyzed mRNA vaccinations until 12 weeks and found no association with RVO, further emphasizing that extending the observation time point for RVO development did not increase the risk of RVO. Further extending the timeline would also increase the risk that patients contract COVID-19 infection, which could itself increase the risk of RVO, confounding results.…”

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

“…Specifically, the relatively short 21-day time frame used in some studies may not be sufficient to fully assess the potential cause-effect association between COVID-19 vaccinations and retinal vascular occlusion (RVO). In a study published in May 2023 by Li et al, a relatively longer time frame was associated with somewhat different conclusions. In their study, 739 066 COVID-19–vaccinated patients from the same TriNetX database with a 1:1 propensity-matched unvaccinated cohort were assessed for occurrences of RVO using the same codes.…”

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

“…Also, several studies have reported RVO after the second dose or booster of the mRNA COVID-19 vaccination, while other reports of vaccine-related occlusion of the central retinal artery/vein have presented no difference between the first and second dose of the COVID-19 vaccination . Dorney et al reported a higher risk of RVO after the first dose of the mRNA COVID-19 vaccination compared with the second dose.…”