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Acute Corneal Transplant Rejection After COVID-19 Vaccination.
Shah, Amar P; Dzhaber, Daliya; Kenyon, Kenneth R; Riaz, Kamran M; Ouano, Dean P; Koo, Ellen H.
  • Shah AP; Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL.
  • Dzhaber D; Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL.
  • Kenyon KR; Cornea Service, New England Eye Center, Tufts University School of Medicine, Boston, MA.
  • Riaz KM; Department of Ophthalmology, Dean McGee Eye Institute/University of Oklahoma, Oklahoma City, OK; and.
  • Ouano DP; Coastal Eye Clinic, New Bern, NC.
  • Koo EH; Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL.
Cornea ; 41(1): 121-124, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1462537
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.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Keratoplasty, Penetrating / Vaccination / Descemet Stripping Endothelial Keratoplasty / SARS-CoV-2 / COVID-19 / 2019-nCoV Vaccine mRNA-1273 / Graft Rejection Type of study: Case report / Diagnostic study / Observational study / Prognostic study Topics: Vaccines Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Cornea Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Keratoplasty, Penetrating / Vaccination / Descemet Stripping Endothelial Keratoplasty / SARS-CoV-2 / COVID-19 / 2019-nCoV Vaccine mRNA-1273 / Graft Rejection Type of study: Case report / Diagnostic study / Observational study / Prognostic study Topics: Vaccines Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Cornea Year: 2022 Document Type: Article