Risk of Corneal Graft Rejection in COVID-19 Vaccinated Patients in the 120-day postoperative period: A Multi-Healthcare System Analysis

ABSTRACT

Purpose: To compare corneal transplant failure in patients who have been vaccinated against COVID-19 to a control group of patients who have received an influenza vaccination. Methods: A retrospective cohort study was conducted using TriNetX, a federated electronic health records research network comprising data from more than 50 health organizations in the United States. Patients who underwent corneal transplantation and either COVID-19 vaccination or Influenza A vaccination were identified by CPT and medication codes and separated into cohorts based which vaccination they had received. COVID-19 vaccination was defined as receiving either 2 doses of Moderna or Pfizer COVID19 Vaccine or 1 dose of J&J's COVID-19 Vaccine. Cohorts were matched for age, gender, body mass index, and medical comorbidities (essential hypertension, diabetes mellitus, chronic lower respiratory diseases, heart failure, nicotine dependence, and alcohol related disorders). The primary outcome was corneal graft failure at 120 days after corneal transplantation surgery. The relative risk for this outcome was compared between each cohort before and after 11 propensity score matching. Results: A study population of 784 corneal transplant patients who received COVID-19 vaccination and a control population of 1661 patients who received Influenza A vaccination were identified. After propensity matching, 715 matched patients from each cohort were compared. The incidence of corneal transplant failure rate was 1.8% for the COVID-19 vaccine cohort and 1.6% for the Influenza A cohort. While the rate of corneal transplant failure was slightly lower in COVID-19 vaccine recipients in comparison to Influenza vaccine recipients (RR=0.92%, CI 0.42-2.01), this result was not statistically significant (p 0.84). Conclusions: While there have been several case reports of corneal graft failure after COVID-19 or COVID-19 vaccination, there appears to be no statistically significant impact of the COVID-19 vaccine on corneal transplant failure in this retrospective cohort study. Additionally, corneal graft rejection in vaccinated patients was rare in our study.