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1.
Ocul Immunol Inflamm ; 30(5): 1278-1281, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35442848

ABSTRACT

PURPOSE: To report a case of multiple evanescent white dot syndrome (MEWDS) following severe acute respiratory syndrome coronavirus 2 vaccination. STUDY DESIGN: Case report. RESULTS: A 36-year-old healthy Taiwanese female was presented with flashing lights in the right eye two days after the first dose of Medigen Vaccine Biologics Corporation (MVC) coronavirus disease 19 (COVID-19) vaccine. Examination of the retina revealed multiple white dots in the posterior pole extending to the mid-periphery. Disruption of ellipsoid zone on optical coherence tomography, early hyperfluorescence on fluorescein angiography, late hypo-cyanescence on indocyanine green angiography, and paracentral scotoma on visual field test were consistent with MEWDS. At four-week follow-up, the patient's fundus lesions resolved, and symptoms subsided without treatment. CONCLUSION: Resembling previous post-vaccine MEWDs cases, the symptoms are self-limited, and the visual prognosis is excellent. The presented case demonstrates MEWDS following MVC COVID-19 vaccine and suggests the immune-mediated basis for MEWDS in predisposed patients.


Subject(s)
Biological Products , COVID-19 Vaccines , COVID-19 , Retinal Diseases , White Dot Syndromes , Adult , Female , Humans , Biological Products/administration & dosage , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Fluorescein Angiography/methods , Indocyanine Green , Retinal Diseases/chemically induced , Retinal Diseases/diagnosis , Tomography, Optical Coherence/methods , Vaccination/adverse effects , White Dot Syndromes/chemically induced
2.
Optom Vis Sci ; 99(6): 534-539, 2022 06 01.
Article in English | MEDLINE | ID: mdl-35412479

ABSTRACT

SIGNIFICANCE: Acute posterior multifocal placoid pigment epitheliopathy is an uncommon inflammatory chorioretinopathy that has been reported after vaccination. This is the first reported case, to our knowledge, after vaccination for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a healthy adolescent boy. PURPOSE: This report aimed to inform the eye care community about a possible ocular sequela of SARS-CoV-2 vaccination. CASE REPORT: A 17-year-old boy presented to a clinic for a second opinion after sudden-onset blind spots in his right eye. His medical history was remarkable for receiving the first dose of the Pfizer-BioNTech SARS-CoV-2 vaccine 2 weeks before symptom onset. He had no history of ocular inflammation, autoimmune disease, or systemic infection. A diagnosis of unilateral acute posterior multifocal placoid pigment epitheliopathy was made based on the presence of typical fundus lesions and noninvasive imaging with fundus autofluorescence, retinal optical coherence tomography, and optical coherence tomography angiography. The diagnosis was further confirmed with fluorescein angiography. The patient developed an anterior vitritis in the right eye 42 days after initial symptom onset. His unilateral intraocular inflammation resolved after a 5-week course of prednisone. CONCLUSIONS: Acute posterior multifocal placoid pigment epitheliopathy is a self-limited inflammatory condition of the outer retina that usually affects young adults and often does not require treatment. It has been reported to occur after vaccination for influenza, polio, hepatitis B, meningococcus C, and varicella zoster virus. This is the first known case to occur after SARS-CoV-2 vaccination in a healthy adolescent boy.


Subject(s)
COVID-19 Vaccines , COVID-19 , White Dot Syndromes , Acute Disease , Adolescent , COVID-19/diagnosis , COVID-19 Vaccines/adverse effects , Fluorescein Angiography , Humans , Inflammation , Male , SARS-CoV-2 , Vaccination/adverse effects , White Dot Syndromes/chemically induced , White Dot Syndromes/diagnosis
3.
Ocul Immunol Inflamm ; 30(5): 1240-1243, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35201960

ABSTRACT

PURPOSE: To describe two cases of multiple evanescent white dot syndrome (MEWDS) occurring after administration of COVID-19 vaccine. STUDY DESIGN: Case Report. RESULTS: Two patients presented soon after receiving their second-dose of the BNT162b2 Pfizer-BioNTech COVID-19 vaccine with findings consistent with MEWDS. Due to the significant reduction in vision, patients were treated with a short dose of oral corticosteroids. Both had complete resolution of their symptoms, visual acuity and retinal findings. CONCLUSIONS: The onset of inflammatory ocular adverse events following COVID-19 vaccinations suggest a maladaptive inflammatory response triggered by the vaccine. Onset of symptoms after COVID-19 vaccinations should prompt the ophthalmologist to assess for these rare adverse events. Despite the extremely rare occurrences of ocular adverse events, we unequivocally recommend that patients receive the full vaccine due to the vast benefit for both individuals and society that far outweighs the inconsiderable risk of harm.


Subject(s)
COVID-19 Vaccines , COVID-19 , Retinal Diseases , White Dot Syndromes , Humans , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Retinal Diseases/diagnosis , Retinal Diseases/drug therapy , Retinal Diseases/etiology , RNA, Messenger , Vaccination/adverse effects , White Dot Syndromes/chemically induced
4.
Ocul Immunol Inflamm ; 30(5): 1222-1227, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35050826

ABSTRACT

INTRODUCTION: Corona virus disease (COVID-19) has been associated with a variety of ophthalmic manifestations including acute macular neuroretinopathy and paracentral middle maculopathy. Posterior segment manifestations after post COVID-19 vaccinations have been reported. CASE REPORT: A 25- year-old Asian Indian female developed sequential bilateral AMN following a single dose of COVISHIELD™ vaccine. On investigations she was found to have a ß thalassemia trait. Presentation started unilaterally and progressed to the other eye after a month. On clinical examination, the fundus was apparently normal in both eyes. Significant changes suggestive of AMN were seen on multimodal imaging of the posterior segment of the respective eye at the time of involvement which resolved spontaneously in due course. CONCLUSION: We report a temporal association of COVID-19 vaccination and AMN.


Subject(s)
COVID-19 Vaccines , COVID-19 , Macula Lutea , White Dot Syndromes , beta-Thalassemia , Adult , Female , Humans , Acute Disease , beta-Thalassemia/complications , beta-Thalassemia/diagnosis , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Multimodal Imaging , Tomography, Optical Coherence/methods , Vaccination , White Dot Syndromes/chemically induced
5.
Ocul Immunol Inflamm ; 30(5): 1234-1239, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35050829

ABSTRACT

PURPOSE: To report two cases of acute macular neuroretinopathy (AMN) in young female patients following the administration of the adenovirus-based coronavirus disease 2019 (COVID-19) vaccine Vaxzevria (AstraZeneca). METHODS: Spectral-domain optical coherence tomography and infrared imaging were used to confirm the diagnosis of AMN. RESULTS: Both patients showed a parafoveal hyperreflective band in the outer nuclear layer, disruption of the ellipsoid and interdigitation zones of the photoreceptor layers, and correlating hyporeflective areas on the near-infrared images. Both patients presented with flu-like fever and sudden onset of fortifications within 48 hours of vaccination. One patient showed altered flow in the deep capillary plexus and highly elevated thrombotic parameters. CONCLUSION: We report a possible association between immune-mediated AMN and the administration of adenovirus-based COVID-19 vaccine Vaxzevria.


Subject(s)
COVID-19 Vaccines , COVID-19 , Macula Lutea , Retinal Diseases , White Dot Syndromes , Female , Humans , Acute Disease , Adenoviridae , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Fluorescein Angiography/methods , Retinal Diseases/diagnosis , Tomography, Optical Coherence/methods , White Dot Syndromes/chemically induced
6.
Medicine (Baltimore) ; 101(2): e28582, 2022 Jan 14.
Article in English | MEDLINE | ID: mdl-35029236

ABSTRACT

RATIONALE: Multiple evanescent white dot syndrome (MEWDS) is an acute, usually unilateral, retinal disorder of unknown etiology that predominantly occurs in healthy young women. We report a case of bilateral asymmetric MEWDS that developed following the first vaccination for coronavirus-19 and worsened after a second vaccination. PATIENT CONCERNS: A 30-year-old Japanese woman was examined in an eye clinic for blurred vision in her left eye for 1 week duration. Thirteen days before her examination, she had received her first BNT162b2 mRNA SARS-CoV-2 vaccination. Her best-corrected visual acuity was 20/20 in both eyes. Fundus examination revealed multiple yellowish-white spots in the perifoveal area of both eyes. Visibility of the spots gradually decreased during the following week. She was then vaccinated with a second dose, and 3 days later, her vision worsened in her left eye. She was then referred to our hospital because of worsened vision and the appearance of white spots on other parts of the retina. Ophthalmological examination revealed a best-corrected visual acuity of 30/20 both eyes. DIAGNOSIS: The flare value in the anterior chamber was elevated in both the eyes. Fundus examination showed multiple white spots in the perifoveal area of both eyes, but they were more prominent in the left eye. Fundus fluorescein angiography revealed early hyperfluorescent spots located circumferentially around the fovea in both eyes. We concluded that the patient had MEWDS, which was most likely due to mRNA COVID-19 immunization. INTERVENTIONS: The patient was treated with topical betamethasone sodium phosphate/fradiomycin sulfate 0.1% thrice daily for 2 months. OUTCOMES: Two months after treatment, her blurry vision resolved with the disappearance of the fundus lesions. LESSON: Clinicians should be aware of potential adverse ocular events following similar vaccinations.


Subject(s)
BNT162 Vaccine/adverse effects , COVID-19/prevention & control , Vision Disorders/etiology , White Dot Syndromes/chemically induced , Adult , BNT162 Vaccine/administration & dosage , COVID-19 Vaccines/administration & dosage , Female , Fluorescein Angiography , Humans , RNA, Messenger , SARS-CoV-2 , Vaccination/adverse effects
7.
JAMA Ophthalmol ; 139(10): 1131-1135, 2021 10 01.
Article in English | MEDLINE | ID: mdl-34473209

ABSTRACT

Importance: As vaccinations against COVID-19 continue, potential ocular adverse events should be reported in detail to increase awareness among the medical community, although typically, a causal relationship cannot be established definitively. Objective: To describe ocular adverse events that occur soon after receiving an inactivated COVID-19 vaccination (Sinopharm). Design, Setting, and Participants: This case series took place from September 2020 to January 2021 at Cleveland Clinic Abu Dhabi, a tertiary referral center. Patients who reported ocular adverse events and presented within 15 days from the first of 2 doses of an inactivated COVID-19 vaccine were analyzed. Main Outcomes and Measures: Each patient underwent Snellen best-corrected visual acuity that was then converted to logMAR, applanation tonometry, and biomicroscopic examination with indirect ophthalmoscopy. Color fundus photography was obtained with a conventional 9-field fundus photography camera or with a widefield fundus photography system. Optical coherence tomography and optical coherence tomographic angiography images were obtained. Sex, race, age, and clinical data were self-reported. Results: Nine eyes of 7 patients (3 male individuals) presenting with ocular complaints following COVID-19 vaccine were included in the study. The mean (SD) age was 41.4 (9.3) years (range, 30-55 years); the mean best-corrected visual acuity was 0.23 logMAR (range, 0-1 logMAR; approximate Snellen equivalent, 20/32). The mean time of ocular adverse event manifestations was 5.2 days (range, 1-10 days). One patient was diagnosed with episcleritis, 2 with anterior scleritis, 2 with acute macular neuroretinopathy, 1 with paracentral acute middle maculopathy, and 1 with subretinal fluid. Conclusions and Relevance: In this case series study of 7 patients, the timing of transient and ocular complications 5.2 days after vaccination with an inactivated COVID-19 vaccine supported an association with the ocular findings, but a causal relationship cannot be established from this study design.


Subject(s)
COVID-19 Vaccines/adverse effects , Eye Diseases/chemically induced , Subretinal Fluid , Vaccination/adverse effects , Adult , COVID-19 Vaccines/administration & dosage , Eye Diseases/diagnosis , Eye Diseases/physiopathology , Female , Humans , Macular Degeneration/chemically induced , Macular Degeneration/diagnosis , Macular Degeneration/physiopathology , Male , Middle Aged , Retrospective Studies , Risk Assessment , Risk Factors , Scleritis/chemically induced , Scleritis/diagnosis , Scleritis/physiopathology , Time Factors , United Arab Emirates , Vaccines, Inactivated/administration & dosage , Vaccines, Inactivated/adverse effects , White Dot Syndromes/chemically induced , White Dot Syndromes/diagnosis , White Dot Syndromes/physiopathology
9.
Ophthalmol Retina ; 4(4): 446-450, 2020 04.
Article in English | MEDLINE | ID: mdl-31926948

ABSTRACT

PURPOSE: Immunotherapy with atezolizumab, a checkpoint inhibitor targeting the programmed cell death 1 (PD-1) axis, has shown promising results for the treatment of certain metastatic cancers. Atezolizumab-associated acute macular neuroretinopathy (AMN) with retinal venulitis is a newly reported immune-related adverse event (irAE) that further expands the range of adverse effects associated with checkpoint inhibitor therapy. We describe the clinical course and imaging findings of a similar AMN-like retinopathy after treatment with atezolizumab. DESIGN: Retrospective case series. PARTICIPANTS: Three patients treated with atezolizumab for metastatic breast cancer (n = 1) and non-small-cell lung cancer (n = 2). METHODS: Inclusion criterion was a clinical diagnosis of AMN-like retinopathy with or without retinal vasculitis after atezolizumab administration. MAIN OUTCOME MEASURES: Clinical course and multimodal retinal imaging including color photographs, spectral-domain OCT, near-infrared reflectance, and fluorescein angiography were investigated. RESULTS: Three patients (1 woman and 2 men; mean age, 51 years) experienced the acute onset of reduced visual acuity and paracentral scotomas 2 weeks after their first infusion of atezolizumab. Visual symptoms corresponded to focal areas of pericentral photoreceptor disruption in all cases. In 1 patient imaged with fluorescein angiography, focal segments of retinal venulitis were detected. After treatment cessation, incomplete visual recovery was related to persistent photoreceptor damage. All patients died of their cancer within 6 months after the onset of retinopathy. CONCLUSIONS: To our knowledge, there are 3 previously published cases of atezolizumab-associated AMN with retinal vasculitis. This series of 3 similar cases strengthens the association of programmed death ligand 1 (PD-L1) inhibition with this rare form of retinopathy that was termed "anti-PD-L1-associated retinopathy." This irAE seems to be a consistent occurrence in the second week postadministration with lasting structural and functional deficits seen after treatment cessation. Pathophysiologic mechanisms may include loss of tolerance in an immune-privileged organ and subsequent development of T-cell-driven inflammation. In this emerging field, expanding the spectrum and pathogenesis of irAEs is essential to define strategies for prevention, early detection, and appropriate management.


Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , B7-H1 Antigen/antagonists & inhibitors , Visual Acuity , White Dot Syndromes/chemically induced , White Dot Syndromes/diagnosis , Adult , Antineoplastic Agents/adverse effects , Breast Neoplasms/drug therapy , Breast Neoplasms/secondary , Female , Fluorescein Angiography/methods , Fundus Oculi , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/secondary , Male , Middle Aged , Prognosis , Retrospective Studies , Tomography, Optical Coherence/methods , White Dot Syndromes/metabolism
10.
BMJ Case Rep ; 12(12)2019 Dec 15.
Article in English | MEDLINE | ID: mdl-31843776

ABSTRACT

This case identifies a newly found association between energy drinks and acute macular neuroretinopathy (AMN). Our patient, a 34-year-old woman with no significant ocular or previous medical history, presented with a 3-day history of decreased vision after consumption of multiple energy drinks. After near infrared and optical coherence tomography imaging, we were able to diagnose her with AMN. Our patient's vision improved over a 2-month course with no intervention. Our case aims to emphasise the effect of caffeine on the retina, as well as encourage clinicians to consider energy drinks as a causative agent of AMN.


Subject(s)
Caffeine/adverse effects , Energy Drinks/adverse effects , White Dot Syndromes/chemically induced , Adult , Caffeine/pharmacology , Female , Humans , Tomography, Optical Coherence , White Dot Syndromes/diagnostic imaging
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