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      A Case of Bilateral Frosted Branch Angiitis after mRNA COVID-19 Vaccination

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          Abstract

          We report a case of bilateral frosted branch angiitis (FBA) following mRNA-1273 COVID-19 vaccination. A 79-year-old male was referred to our hospital with a sudden onset of blurred vision in the right eye, which occurred during his return home after receiving the third dose of a messenger RNA (mRNA) COVID-19 vaccine. Fundoscopy revealed severe retinal vasculitis with sheathing of the artery and vein in the right eye more so than in the left eye, suggestive of bilateral FBA. Optical coherence tomography showed significant macular edema and serous retinal detachment in the right eye. Polymerase chain reaction assay detected Epstein-Barr virus (EBV) in the aqueous humor, and antibody against the EBV viral capsid antigen was positive for IgM. The next day, best-corrected visual acuity (BCVA) worsened to 0.08 due to macular edema in the left eye. After 2 courses of pulse steroid therapy and intravenous infusion of acyclovir, macular edema had disappeared and sheathing of retinal vessels was improving. At 5 months after the mRNA COVID-19 vaccination, BCVA was maintained 0.15 in the right eye and 0.7 in the left eye. Severe uveitis, such as FBA, can occur after mRNA COVID-19 vaccination.

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          Most cited references14

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          Uveitis following the BNT162b2 mRNA vaccination against SARS-CoV-2 infection : a possible association

          To describe uveitis cases after the BNT162b2 mRNA SARS-CoV-2 vaccination.
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            Real‐world evidence from over one million COVID ‐19 vaccinations is consistent with reactivation of the varicella‐zoster virus

            Abstract Background Reactivation of the varicella‐zoster virus (VZV), which causes herpes zoster (HZ, synonym: shingles) in humans, can be a rare adverse reaction to vaccines. Recently, reports of cases after COVID‐19 vaccination have arisen. Objectives The aim of this study was to assess whether the frequency of HZ is found to increase after COVID‐19 vaccination in a large cohort, based on real‐world data. As a hypothesis, the incidence of HZ was assumed to be significantly higher in subjects who received a COVID‐19 vaccine (Cohort I) vs. unvaccinated individuals (Cohort II). Methods The initial cohorts of 1 095 086 vaccinated and 16 966 018 unvaccinated patients were retrieved from the TriNetX database and were matched on age and gender in order to mitigate confounder bias. Results After matching, each cohort accounted for 1 095 086 patients. For the vaccinated group (Cohort I), 2204 subjects developed HZ within 60 days of COVID‐19 vaccination, while among Cohort II, 1223 patients were diagnosed with HZ within 60 days after having visited the clinic for any other reason (i.e. not vaccination). The risk of developing shingles was calculated as 0.20% and 0.11% for cohort I and cohort II, respectively. The difference was statistically highly significant (P < 0.0001; log‐rank test). The risk ratio and odds ratio were 1.802 (95% confidence interval [CI] = 1.680; 1.932) and 1.804 (95% CI = 1.682; 1.934). Conclusions Consistent with the hypothesis, a higher incidence of HZ was statistically detectable post‐COVID‐19 vaccine. Accordingly, the eruption of HZ may be a rare adverse drug reaction to COVID‐19 vaccines. Even though the molecular basis of VZV reactivation remains murky, temporary compromising of VZV‐specific T‐cell‐mediated immunity may play a mechanistic role in post‐vaccination pathogenesis of HZ. Note that VZV reactivation is a well‐established phenomenon both with infections and with other vaccines (i.e. this adverse event is not COVID‐19‐specific).
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              Acute macular neuroretinopathy (AMN) following COVID-19 vaccination

              Purpose To describe a case of acute macular neuroretinopathy (AMN) in a 23-year-old Caucasian female after a COVID-19 vaccination (Vaxzevira). Observations Our patient perceived visual symptoms in both eyes one day after COVID-19 vaccination. Hyporeflective petalloid shaped perifoveal lesions appeared in infrared reflectance (IR) imaging, and Spectral domain-optical coherence tomography (SD-OCT) revealed structural alterations of outer retinal layers that resulted in persistent disruption of the ellipsoid zone (EZ) and the interdigitation zone (IZ). Conclusions and importance We report a novel association between AMN and COVID-19 vaccination. In addition to a febrile infection and oral contraception, previous vaccination should also be considered a potential risk factor for AMN.
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                Author and article information

                Journal
                Case Rep Ophthalmol
                Case Rep Ophthalmol
                COP
                COP
                Case Reports in Ophthalmology
                S. Karger AG (Basel, Switzerland )
                1663-2699
                10 July 2023
                Jan-Dec 2023
                10 July 2023
                : 14
                : 1
                : 295-300
                Affiliations
                [1]Division of Ophthalmology, Department of Visual Sciences/Nihon University School of Medicine/Itabashi, Tokyo, Japan
                Author notes
                Correspondence to: Takako Ohnishi, oonishi.takako@ 123456nihon-u.ac.jp
                Article
                530794
                10.1159/000530794
                10350867
                37465117
                cded9db2-189e-4380-9ce8-5e311da3e80a
                © 2023 The Author(s). Published by S. Karger AG, Basel

                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
                : 8 December 2022
                : 11 April 2023
                : 2023
                Page count
                Figures: 3, References: 14, Pages: 6
                Funding
                No funding or grant support was received in association with this study.
                Categories
                Case Report

                mrna covid-19 vaccination,frosted branch angiitis,epstein-barr virus,uveitis

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