We present a rare case of acute retinal pigment epitheliitis (ARPE) following vaccination. An 18-year-old Japanese man visited our hospital with a 5-day history of a central scotoma in the right eye. He had received the second dose of coronavirus disease 2019 vaccination (BNT162b2 mRNA, Pfizer-BioNTech) 1 month prior, following which he developed a low-grade fever of 37.3–37.5°C for 2 days accompanied by joint pain. Although he had received influenza vaccination 5 days prior to this presentation, no systemic symptoms other than injection site pain were observed. Blood test results were unremarkable. Ophthalmological examination revealed a decimal best-corrected visual acuity (BCVA) of 0.8 and 1.2 in the right and left eyes, respectively. Intraocular pressure was 15 mm Hg in both eyes. Intraocular inflammation was not observed. Fundus examination revealed a localized lesion of pigment stippling associated with yellowish hypopigmentation in the fovea. Fluorescein angiography revealed slight transmission hyperfluorescence without leakage. Optical coherence tomography (OCT) revealed disruption of the external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ). We diagnosed the patient with ARPE in the right eye. The patient was followed up without treatment. Five weeks after onset, the central scotoma in the right eye disappeared, and patient’s BCVA in the right eye improved to 1.5. OCT showed improvement in ELM and EZ continuity in the right eye, but IZ remained disruptive. Although the exact pathophysiology of the association between ARPE and these vaccinations is unclear, ARPE may develop after the vaccination.

The study aimed to describe a case of rapid progression of polypoidal choroidal vasculopathy (PCV) following the third administration of the Pfizer-BioNTech (BNT162b2) mRNA vaccine. A 79-year-old Japanese man visited our hospital with a 1-week history of blurred vision in the left eye 16 h following the administration of the third BNT162b2 mRNA vaccine. The clinical examinations and imaging tests revealed massive submacular hemorrhage (SMH) and excessive subretinal fluid (SRF), owing to PCV in the left eye. No ocular abnormality was observed in the right eye. His medical history included diabetes and ocular history included cataracts, nonproliferative diabetic retinopathy, glaucoma in both eyes, and irregular retinal pigment epithelium elevation in the left eye. Since he received a single intravitreal injection of aflibercept approximately 2 years ago for the treatment of diabetic macular edema in the left eye, the left eye was stable. We performed an intravitreal injection of bevacizumab and combined phacoemulsification with pars plana vitrectomy with gas, including subretinal injection of tissue plasminogen activator to displace the SMH. Thirteen days after the surgery, the SMH and SRF decreased. Although rare, mRNA COVID-19 vaccine administrations could be associated with PCV deterioration.