Clinical Image

Central retinal vein occlusion following mRNA severe acute respiratory syndrome coronavirus 2 vaccination

Kumiko Noguchi¹

Ryota Takahashi¹

Shinji Makino¹

¹ Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan

Address correspondence to:

Kumiko Noguchi

Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi,

Japan

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Article ID: 101337Z01KN2022

doi: 10.5348/101337Z01KN2022CI

How to cite this article

Noguchi K, Takahashi R, Makino S. Central retinal vein occlusion following mRNA severe acute respiratory syndrome coronavirus 2 vaccination. Int J Case Rep Images 2022;13(2):105–107.

ABSTRACT

No Abstract

Keywords: Central retinal vein occlusion, Coronavirus disease 2019 (COVID-19) vaccination, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Case Report

A 46-year-old healthy woman presented with a 6-day history of visual disturbance in the right eye after she received the second dose of the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. Examination revealed best-corrected visual acuity of 12/20 in the right eye. Fundoscopy revealed venous dilatation and tortuosity with dispersed dot and flame-shaped hemorrhages (Figure 1), and the patient was diagnosed with impending central retinal vein occlusion (CRVO). She was treated using an intravitreal injection of ranibizumab and showed a favorable response. During three months of follow-up, visual acuity improved to 20/20 (Figure 2).

Figure 1: Fundus photograph of the right eye showing venous dilatation and tortuosity with dispersed dot and flame-shaped hemorrhages.

Figure 2: Fundus photograph after the treatment showing improvement of CRVO.

Discussion

Few reports in the literature describe CRVO following COVID-19 vaccination [1],[2],[3]. Endo et al. [1] reported CRVO 15 days after the first dose of the BNT162b2 vaccine in a 52-year-old healthy man. Shah et al. [2] reported CRVO a few days after the first dose of the BNT162b2 vaccine in a 27-year-old healthy woman. Sonawane et al. [3] reported CRVO four days after the second dose of the ChAdOX1 nCoV-19 (Oxford University/AstraZeneca) vaccine in a 50-year-old man with diabetes. To our knowledge, this present case is the first report of CRVO, which was temporally associated with COVID-19 vaccination in Japan.

COVID-19 vaccines trigger the production of high levels of neutralizing antibodies, which recognize and target the spike proteins of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and destroy it before dissemination of the virus and the onset of illness [4]. Neutralizing antibodies that develop against the spike proteins and/or activated T-helper-1 cells after vaccination can cross-react with proteins and antigens in large arteries, the outer retinal layers, and retinal pigment epithelial cells [4],[5].

Conclusion

Whether CRVO observed after SARS-CoV-2 vaccination was consequential or coincidental in the present case remains unclear; however, we speculate that the close temporal association with COVID-19 vaccination suggests the possibility of vasculopathy against a background of inflammatory or post-vaccine thrombotic reactions to the timing of onset of CRVO.

REFERENCES

Endo B, Bahamon S, Martínez-Pulgarín DF. Central retinal vein occlusion after mRNA SARS-CoV-2 vaccination: A case report. Indian J Ophthalmol 2021;69(10):2865–6. [CrossRef] [Pubmed] Back to citation no. 1

Shah PP, Gelnick S, Jonisch J, Verma R. Central retinal vein occlusion following BNT162b2 (Pfizer-BioNTech) COVID-19 messenger RNA vaccine. Retin Cases Brief Rep 2021. [CrossRef] [Pubmed] Back to citation no. 1

Sonawane NJ, Yadav D, Kota AR, Singh HV. Central retinal vein occlusion post-COVID-19 vaccination. Indian J Ophthalmol 2022;70(1):308–9. [CrossRef] [Pubmed] Back to citation no. 1

Maleki A, Look-Why S, Manhapra A, Foster CS. COVID-19 recombinant mRNA vaccines and serious ocular inflammatory side effects: Real or coincidence? J Ophthalmic Vis Res 2021;16(3):490–501. [CrossRef] [Pubmed] Back to citation no. 1

Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 2021;384(22):2092–101. [CrossRef] [Pubmed] Back to citation no. 1

SUPPORTING INFORMATION

Author Contributions

Kumiko Noguchi - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Ryota Takahashi - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Shinji Makino - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published

Data Availability Statement

The corresponding author is the guarantor of submission.

Consent For Publication

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Competing Interests

Authors declare no conflict of interest.

Copyright

© 2022 Kumiko Noguchi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.