CORNEAL GRAFT REJECTIONS DUE TO COVID 19 INFECTION OR VACCINATIONS : A CASE SERIES

ABSTRACT

Purpose: To report 4 cases of corneal graft rejections which occurred due to COVID19 infection or vaccination. Methods: Case 1 A 24-year old woman presented with corneal scar in her right eye (due to a resolved microbial keratitis) for which she underwent optical penetrating keratoplasty (PK). The patient presented with hyperacute endothelial rejection 5 weeks later. She had epithelial and endothelial corneal graft rejection (Figure 1) for which she was treated with intravenous methylprednisolone, along with topical steroids prescribed hourly and systemic steroids. 3 days later, she was diagnosed with COVID 19 infection. In spite of adequate treatment, her corneal graft could not be salvaged. Case 2 A 31-year old male who had history of chemical injury in the right eye in 2017, underwent second PK in 2020, and had graft rejection 4 weeks after 1st dose of COVID vaccine (COVISHIELD). He was successfully treated with hourly topical steroids along with systemic steroids and the corneal graft cleared up. Case 3 Another 29-year old male diagnosed with Macular corneal dystrophy underwent corneal transplantation in 2016 had graft rejection following 1st dose of COVID vaccine (COVISHIELD) 3 weeks later. The patient was treated with topical and systemic steroids. Though most part of the graft cleared up but inferior graft edema was found to persist (Figure 2). Case 4 A 17-year old girl, underwent PK for Congenital Hereditary Endothelial Dystrophy and had corneal graft rejection 1 month after the 2nd dose of COVID vaccine (COVISHIELD). With adequate treatment of topical and systemic steroids, the patient's corneal graft improved and cleared up, and the patient reports an improvement in visual acuity as well. Results:-Conclusions: COVID 19 infection and vaccination can induce graft rejection. Hyperacute endothelial rejection is possible with COVID 19 infection. COVID vaccine related corneal graft rejections may be less severe and may be reversed with adequate treatment.