Vaccine-associated corneal graft rejection following SARS-CoV-2 vaccination: a CDC-VAERS database analysis

Abstract

PurposeTo evaluate the cases of corneal graft rejection following SARS-CoV-2 vaccination reported to Centers for Disease Control and Prevention Vaccine Adverse Event Reporting System.MethodsA descriptive analysis of the demographics, clinical history and presentation was performed. We evaluated the correlation between the vaccines and duration of vaccine-associated graft rejection (VAR) onset following vaccination using a one-way analysis of variance test. A post hoc analysis was performed between VAR onset-interval following vaccination dose and vaccine type. Finally, a 30-day cumulative incidence analysis was performed to assess the risk of VAR in short term following different doses, vaccines and type of corneal transplantation.ResultsA total of 55 eyes of 46 patients were diagnosed with VAR following vaccination with BNT162b2 (73.91%) and mRNA-1273 (26.09%). The mean age of the patients was 62.76±15.83 years, and 28 (60.87%) were female. The patients diagnosed with VAR had undergone penetrating keratoplasty (61.82%), Descemet membrane endothelial keratoplasty (12.73%), descemet stripping endothelial keratoplasty (18.18%), anterior lamellar keratoplasty (3.64%) and corneal limbal allograft transplantation (1.82%). The mean time for VAR since penetrating and endothelial keratoplasty was 8.42±9.23 years and 4.18±4.40 years, respectively. 45.65% of the cases of VAR were reported after the second dose of vaccine. The duration of VAR onset was significantly shorter after the second dose compared with the first and booster doses (p=0.0165) and in patients who underwent endothelial keratoplasty compared with penetrating keratoplasty (p=0.041).ConclusionsThis study outlines a possible temporal relationship between corneal graft rejection and SARS-CoV-2 vaccination. An earlier onset of VAR was observed in patients who had a history of endothelial keratoplasty and following the second dose of vaccination.

Corneal Adverse Events Associated with SARS-CoV-2/COVID-19 Vaccination: A Systematic Review

“…Interestingly, a recent study using the Centers for Disease Control and Prevention Vaccine Adverse Events Reporting System demonstrated a temporal association between vaccine-associated uveitis (VAU) and SARS-CoV-2 vaccination. Among 491 patients diagnosed with VAU, 249 (20.76%) had herpes ophthalmicus (unspecified) [ 9 ]. They also noted that the benefits of vaccination outweigh the risks of VAU but that physicians should be aware of this association.…”

“…Organ-specific adverse events are largely limited to case series and case reports. Case reports and retrospective case series have described possible associations between the administration of the SARS-CoV-2 vaccine and the onset of ophthalmic complications involving the eyelid, orbit, cornea, retina, and other ocular structures [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. There are numerous reports of corneal complications in particular.…”

Risk of Corneal Transplant Rejection Following COVID-19 Vaccination: A Systematic Review and Meta-analysis

“…The introduction of the COVID-19 vaccine has sparked a debate over its potential impact on the incidence or intensity of corneal transplant rejection [ 12 ]. This speculation is rooted in the notion that the vaccine's systemic immune activation could amplify the immune response to the transplanted corneal tissue, thereby elevating the risk of graft rejection [ 13 ].…”

Posterior Scleritis Following COVID-19 Vaccination or Infection Simulating Uveal Melanoma in 8 Consecutive Patients

“…[9][10][11] There is emerging evidence that COVID-19 vaccination or infection could lead to in ammatory eye conditions, although the risk appears to be low with only a few cases of COVID-19 vaccine-associated uveitis reported in the peer-reviewed literature to date (however this might be due to under-reporting bias). [12][13][14][15][16][17][18] In ammatory eye conditions linked to COVID-19 vaccination appear to be self-limiting and with minimal visual impact and reports of posterior scleritis following COVID-19 vaccination are exquisitely rare. 19 We experienced a rise in referrals to our ocular oncology service for possible intraocular tumor that proved to be posterior scleritis during the COVID-19 pandemic.…”