Amar P Shah1, Daliya Dzhaber1, Kenneth R Kenyon2, Kamran M Riaz3, Dean P Ouano4, Ellen H Koo1. 1. Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL. 2. Cornea Service, New England Eye Center, Tufts University School of Medicine, Boston, MA. 3. Department of Ophthalmology, Dean McGee Eye Institute/University of Oklahoma, Oklahoma City, OK; and. 4. Coastal Eye Clinic, New Bern, NC.
Abstract
PURPOSE: The purpose of this report was to describe 4 cases of acute corneal transplant rejection occurring in association with coronavirus disease 2019 (COVID-19) mRNA vaccination. METHODS: Four patients with prior keratoplasty developed presumed immunologic rejection after the mRNA-1273 vaccination for coronavirus 2 (SARS-CoV-2). Case 1 had received Descemet membrane endothelial keratoplasty 6 months ago and presented with endothelial graft rejection 3 weeks after the first vaccine dose. Case 2 had undergone penetrating keratoplasty 3 years previously and presented with acute endothelial rejection 9 days after the second vaccine dose. Case 3 had prior Descemet stripping automated endothelial keratoplasty (DSAEK) and began experiencing symptoms of endothelial graft rejection 2 weeks after the second vaccine dose. Case 4 presented with endothelial rejection of the penetrating keratoplasty graft 2 weeks after the second vaccine dose. RESULTS: Frequent topical corticosteroids alone were initiated in all 4 cases. In case 1, the endothelial rejection line appeared fainter with improvement in visual acuity and corneal edema 5 weeks after diagnosis. Case 2 experienced complete resolution of corneal stromal edema and rejection line 6 weeks after diagnosis. Cases 3 and 4 have both experienced initial improvement with steroid treatment as well. CONCLUSIONS: These cases suggest acute corneal endothelial rejection may occur soon after either dose of the COVID-19 mRNA vaccine. Prompt initiation of aggressive topical steroid therapy may result in complete resolution of clinical signs and symptoms. Further studies are needed to elucidate the causal mechanism of corneal graft rejection after COVID-19 vaccination.
PURPOSE: The purpose of this report was to describe 4 cases of acute corneal transplant rejection occurring in association with coronavirus disease 2019 (COVID-19) mRNA vaccination. METHODS: Four patients with prior keratoplasty developed presumed immunologic rejection after the mRNA-1273 vaccination for coronavirus 2 (SARS-CoV-2). Case 1 had received Descemet membrane endothelial keratoplasty 6 months ago and presented with endothelial graft rejection 3 weeks after the first vaccine dose. Case 2 had undergone penetrating keratoplasty 3 years previously and presented with acute endothelial rejection 9 days after the second vaccine dose. Case 3 had prior Descemet stripping automated endothelial keratoplasty (DSAEK) and began experiencing symptoms of endothelial graft rejection 2 weeks after the second vaccine dose. Case 4 presented with endothelial rejection of the penetrating keratoplasty graft 2 weeks after the second vaccine dose. RESULTS: Frequent topical corticosteroids alone were initiated in all 4 cases. In case 1, the endothelial rejection line appeared fainter with improvement in visual acuity and corneal edema 5 weeks after diagnosis. Case 2 experienced complete resolution of corneal stromal edema and rejection line 6 weeks after diagnosis. Cases 3 and 4 have both experienced initial improvement with steroid treatment as well. CONCLUSIONS: These cases suggest acute corneal endothelial rejection may occur soon after either dose of the COVID-19 mRNA vaccine. Prompt initiation of aggressive topical steroid therapy may result in complete resolution of clinical signs and symptoms. Further studies are needed to elucidate the causal mechanism of corneal graft rejection after COVID-19 vaccination.
Authors: Saad Alhumaid; Ali A Rabaan; Kuldeep Dhama; Shin Jie Yong; Firzan Nainu; Khalid Hajissa; Nourah Al Dossary; Khulood Khaled Alajmi; Afaf E Al Saggar; Fahad Abdullah AlHarbi; Mohammed Buhays Aswany; Abdullah Abdulaziz Alshayee; Saad Abdalaziz Alrabiah; Ahmed Mahmoud Saleh; Mohammed Ali Alqarni; Fahad Mohammed Al Gharib; Shahd Nabeel Qattan; Hassan M Almusabeh; Hussain Yousef AlGhatm; Sameer Ahmed Almoraihel; Ahmed Saeed Alzuwaid; Mohammed Ali Albaqshi; Murtadha Ahmed Al Khalaf; Yasmine Ahmed Albaqshi; Abdulsatar H Al Brahim; Mahdi Mana Al Mutared; Hassan Al-Helal; Header A Alghazal; Abbas Al Mutair Journal: Vaccines (Basel) Date: 2022-08-10