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Central retinal vein occlusion following mRNA severe acute respiratory syndrome coronavirus 2 vaccination
1 Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan
Address correspondence to:
Kumiko Noguchi
Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi,
Japan
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Article ID: 101337Z01KN2022
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Noguchi K, Takahashi R, Makino S. Central retinal vein occlusion following mRNA severe acute respiratory syndrome coronavirus 2 vaccination. Int J Case Rep Images 2022;13(2):105–107.ABSTRACT
No Abstract
Keywords: Central retinal vein occlusion, Coronavirus disease 2019 (COVID-19) vaccination, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Case Report
A 46-year-old healthy woman presented with a 6-day history of visual disturbance in the right eye after she received the second dose of the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. Examination revealed best-corrected visual acuity of 12/20 in the right eye. Fundoscopy revealed venous dilatation and tortuosity with dispersed dot and flame-shaped hemorrhages (Figure 1), and the patient was diagnosed with impending central retinal vein occlusion (CRVO). She was treated using an intravitreal injection of ranibizumab and showed a favorable response. During three months of follow-up, visual acuity improved to 20/20 (Figure 2).
Discussion
Few reports in the literature describe CRVO following COVID-19 vaccination [1],[2],[3]. Endo et al. [1] reported CRVO 15 days after the first dose of the BNT162b2 vaccine in a 52-year-old healthy man. Shah et al. [2] reported CRVO a few days after the first dose of the BNT162b2 vaccine in a 27-year-old healthy woman. Sonawane et al. [3] reported CRVO four days after the second dose of the ChAdOX1 nCoV-19 (Oxford University/AstraZeneca) vaccine in a 50-year-old man with diabetes. To our knowledge, this present case is the first report of CRVO, which was temporally associated with COVID-19 vaccination in Japan.
COVID-19 vaccines trigger the production of high levels of neutralizing antibodies, which recognize and target the spike proteins of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and destroy it before dissemination of the virus and the onset of illness [4]. Neutralizing antibodies that develop against the spike proteins and/or activated T-helper-1 cells after vaccination can cross-react with proteins and antigens in large arteries, the outer retinal layers, and retinal pigment epithelial cells [4],[5].
Conclusion
Whether CRVO observed after SARS-CoV-2 vaccination was consequential or coincidental in the present case remains unclear; however, we speculate that the close temporal association with COVID-19 vaccination suggests the possibility of vasculopathy against a background of inflammatory or post-vaccine thrombotic reactions to the timing of onset of CRVO.
REFERENCES
1.
Endo B, Bahamon S, Martínez-Pulgarín DF. Central retinal vein occlusion after mRNA SARS-CoV-2 vaccination: A case report. Indian J Ophthalmol 2021;69(10):2865–6. [CrossRef]
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2.
Shah PP, Gelnick S, Jonisch J, Verma R. Central retinal vein occlusion following BNT162b2 (Pfizer-BioNTech) COVID-19 messenger RNA vaccine. Retin Cases Brief Rep 2021. [CrossRef]
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Sonawane NJ, Yadav D, Kota AR, Singh HV. Central retinal vein occlusion post-COVID-19 vaccination. Indian J Ophthalmol 2022;70(1):308–9. [CrossRef]
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Maleki A, Look-Why S, Manhapra A, Foster CS. COVID-19 recombinant mRNA vaccines and serious ocular inflammatory side effects: Real or coincidence? J Ophthalmic Vis Res 2021;16(3):490–501. [CrossRef]
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Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 2021;384(22):2092–101. [CrossRef]
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SUPPORTING INFORMATION
Author Contributions
Kumiko Noguchi - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ryota Takahashi - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Shinji Makino - Conception of the work, Design of the work, Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Kumiko Noguchi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
