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      Central Retinal Vein Occlusion after mRNA COVID-19 Vaccination

      case-report

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          Abstract

          A 47-year-old man presented with visual loss in the right eye 8 h after the first dose of a coronavirus disease 2019 (COVID-19) vaccine developed by Pfizer/BioNTech (BNT162b2). The best corrected visual acuity (BCVA) was 20/200. Fundus examination showed dilated and tortuous retinal veins at the posterior pole, retinal hemorrhages throughout the fundus, and macular edema. Fluorescein angiography showed multiple hypofluorescent spots that appeared to be fluorescent block due to retinal hemorrhages and hyperfluorescent leakage from the retinal veins. The eye was diagnosed with central retinal vein occlusion (CRVO). For the treatment of macular edema, intravitreal injection of aflibercept (IVA) was administered and treated with one plus pro re nata regimen. Five IVAs were performed over a 10-month follow-up period, with resolution of macular edema, and the BCVA recovered to 20/20. The patient was young and had no history of diabetes mellitus, hypertension, or atherosclerotic diseases, and his blood tests showed no abnormal findings. Both antigen test and polymerase chain reaction test for COVID-19 were negative, and the antibody test was positive due to vaccination. The development of CRVO in this patient may have been related to COVID-19 vaccination, and the appropriate IVA treatment resulted in a good visual prognosis.

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          Most cited references21

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          Hematological findings and complications of COVID ‐19

          Evangelos Terpos, Ioannis Ntanasis-Stathopoulos, Ismail Elalamy … (2020)
          Abstract COVID‐19 is a systemic infection with a significant impact on the hematopoietic system and hemostasis. Lymphopenia may be considered as a cardinal laboratory finding, with prognostic potential. Neutrophil/lymphocyte ratio and peak platelet/lymphocyte ratio may also have prognostic value in determining severe cases. During the disease course, longitudinal evaluation of lymphocyte count dynamics and inflammatory indices, including LDH, CRP and IL‐6 may help to identify cases with dismal prognosis and prompt intervention in order to improve outcomes. Biomarkers, such high serum procalcitonin and ferritin have also emerged as poor prognostic factors. Furthermore, blood hypercoagulability is common among hospitalized COVID‐19 patients. Elevated D‐Dimer levels are consistently reported, whereas their gradual increase during disease course is particularly associated with disease worsening. Other coagulation abnormalities such as PT and aPTT prolongation, fibrin degradation products increase, with severe thrombocytopenia lead to life‐threatening disseminated intravascular coagulation (DIC), which necessitates continuous vigilance and prompt intervention. So, COVID‐19 infected patients, whether hospitalized or ambulatory, are at high risk for venous thromboembolism, and an early and prolonged pharmacological thromboprophylaxis with low molecular weight heparin is highly recommended. Last but not least, the need for assuring blood donations during the pandemic is also highlighted.
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            Retinal findings in patients with COVID-19

            Paula M. Marinho, Allexya A A Marcos, Andre C. Romano … (2020)
            Coronavirus disease 2019 (COVID-19) has been shown to affect different parts of the body, and ophthalmological changes have been associated with ocular external diseases such as conjuntivitis 1 . Optical coherence tomography (OCT) is a non-invasive imaging technique that is useful for demonstrating subclinical retinal changes in systemic conditions such as diabetes, Parkinson's disease, and Alzheimer's disease, as well as many viral infections. 2 We used OCT to evaluate patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The protocol was approved by INVIRARE Pesquisa Clínica Auditoria e Consultoria Institutional Review Board Ethics Committee. Here we report retinal and OCT changes in 12 adults (six men and six women, aged 25–69 years), examined 11–33 days after COVID-19 symptom onset. All patients had fever, asthenia, and dyspnoea, and 11 patients also presented with anosmia. Two patients were admitted to hospital but none required intensive care. Nine patients were physicians, and two were health-care workers. All patients had normal blood parameters at the time of ophthalmological evaluation. Nine patients tested positive for SARS-CoV-2 by PCR (using nasal and oral swabs), and two patients tested positive in antibody tests for COVID-19. Two different OCT devices were used: DRI-OCT Triton Swept Source (Topcon, Tokyo, Japan) and XR Avanti SD-OCT (Optovue, Fremont, CA, USA). All patients showed hyper-reflective lesions at the level of ganglion cell and inner plexiform layers more prominently at the papillomacular bundle in both eyes (figure ). Results of OCT-angiography and ganglionar cells complex analysis appeared normal. Furthermore, four patients presented subtle cotton wool spots and microhaemorrhages along the retinal arcade, observed on fundus examination, color fundus photography, and red-free imaging. Visual acuity and pupillary reflexes were normal in all eyes, and we detected no symptoms or signs of intraocular inflammation. Figure Retinal findings in four patients with COVID-19 Panels A-D represent four different patients. (A) Colour fundus photography and red-free imaging show a cotton wool spot at the superior retinal arcade with subtle microhaemorrhage. (B–D) Cross-sectional B-scan OCT in three patients shows hyper-reflective lesions at the level of the inner plexiform and ganglion cell layers, a feature observed in all patients. COVID-19=coronavirus disease 2019. OCT=optical coherence tomography. Although animal models suggest ocular lesions could include retinitis and optic neuritis,3, 4 this is, to the best of our knowledge, the first report of retinal findings possibly associated with COVID-19 infection in humans. Ganglion cell and plexiform layer findings could be associated with CNS manifestations that have been described in animal studies 4 and in COVID-19 neurological events. 5
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              First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland

              C Simpson, T. Shi, E. Vasileiou … (2021)
              Reports of ChAdOx1 vaccine–associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse events using a nested incident-matched case-control study and a confirmatory self-controlled case series (SCCS) analysis. An association was found between ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0–27 d after vaccination; adjusted rate ratio (aRR) = 5.77, 95% confidence interval (CI), 2.41–13.83), with an estimated incidence of 1.13 (0.62–1.63) cases per 100,000 doses. An SCCS analysis confirmed that this was unlikely due to bias (RR = 1.98 (1.29–3.02)). There was also an increased risk for arterial thromboembolic events (aRR = 1.22, 1.12–1.34) 0–27 d after vaccination, with an SCCS RR of 0.97 (0.93–1.02). For hemorrhagic events 0–27 d after vaccination, the aRR was 1.48 (1.12–1.96), with an SCCS RR of 0.95 (0.82–1.11). A first dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. The attenuation of effect found in the SCCS analysis means that there is the potential for overestimation of the reported results, which might indicate the presence of some residual confounding or confounding by indication. Public health authorities should inform their jurisdictions of these relatively small increased risks associated with ChAdOx1. No positive associations were seen between BNT162b2 and thrombocytopenic, thromboembolic and hemorrhagic events. New data from the EAVE II cohort in Scotland suggests that a first dose of the ChAdOx1 nCoV-19 vaccine might be associated with a small increase in the risk of idiopathic thrombocytopenic purpura between 0 and 27 d after vaccination.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Ophthalmol
                Journal ID (iso-abbrev): Case Rep Ophthalmol
                Journal ID (hwp): COP
                Journal ID (publisher-id): COP
                Title: Case Reports in Ophthalmology
                Publisher: S. Karger AG (Basel, Switzerland )
                ISSN (Electronic): 1663-2699
                Publication date (Electronic): 25 May 2023
                Publication date Collection: Jan-Dec 2023
                Publication date PMC-release: 25 May 2023
                Volume: 14
                Issue: 1
                Pages: 234-240
                Affiliations
                [a ]Department of Ophthalmology, Ogaki Tokushukai Hospital, Ogaki, Japan
                [b ]Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
                Author notes
                Correspondence to: Yoshio Hirano, yoshio.hirano@ 123456gmail.com
                Article
                Publisher ID: 530697
                DOI: 10.1159/000530697
                PMC ID: 10293943
                PubMed ID: 37383170
                SO-VID: c5fbcb9f-5fa7-4056-9233-4b7f2197c6e8
                Copyright © © 2023 The Author(s). Published by S. Karger AG, Basel
                License:

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ( http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                Date received : 30 January 2023
                Date accepted : 11 April 2023
                Date: 2023
                Page count
                Figures: 3, Tables: 1, References: 21, Pages: 7
                Funding
                There is no funding source.
                Categories
                Subject: Case Report

                Keywords: central retinal vein occlusion,vaccine,covid-19,mrna
                Data availability:
                Keywords: central retinal vein occlusion, vaccine, covid-19, mrna

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