After the Storm: Ophthalmic Manifestations of COVID-19 Vaccines

Abstract

Several COVID-19 vaccines have been developed and approved for use around the world from December 2020, to combat the pandemic caused by the novel SARS-CoV-2 virus. Several ophthalmic manifestations of the COVID-19 vaccines have been reported by ophthalmologists. This review was undertaken to recognize, encourage active reporting and determine the pathogenesis and time of appearance for better awareness and understanding of the ophthalmic manifestations of COVID-19 vaccines. A literature search was performed for publications on the ophthalmic manifestations of COVID-19 vaccines between January 1, 2021 and November 7, 2021. 23 case reports, 17 letters to editors, 3 ophthalmic images, 4 brief communications, 4 retrospective cohort studies and 2 case control studies were included. Posterior segment, including the uvea, choroid and retinal vasculature, was most commonly affected and the reported clinical features developed at a median of four days from the time of vaccination. The possible mechanisms include molecular mimicry of the vaccine components with host ocular tissues, antigen-specific cell and antibody-mediated hypersensitivity reactions to viral antigens and adjuvants present in the vaccines. The causal relationship of the ocular signs and symptoms and COVID-19 vaccines has not been established and requires long-term and large multicentre data. Most of the reported manifestations are mild, transient and adequately treated when diagnosed and managed early. The benefits of COVID-19 vaccination outweighs the reported rare adverse events and should not be a deterrent to vaccination.

Susac Syndrome Following COVID-19 Vaccination: A Case Report

“…The immunological response to the spike antigen or to components of the chimpanzee or human adenovirus can cause ocular diseases [ 4 ]. Recently, several systemic reviews of the COVID-19 vaccine have demonstrated multiple ocular manifestations following vaccination with the ChAdOx1 vaccine, which included corneal graft rejection, acute macular neuroretinopathy (AMN), multifocal choroiditis, acute retinal necrosis, and optic neuritis with longitudinal extensive transverse myelitis [ 4 , 15 ]. Superior ophthalmic vein thrombosis and cerebral venous sinus thrombosis were also reported following the ChAdOx1 vaccine, which may be also related to the mechanism of VITT.…”

Vaksinasi COVID-19 dan Kesehatan Mata

“…Edema kelopak mata mungkin bagian dari reaksi anafilaksis, namun tidak ada gejala sistemik yang dilaporkan. 14 Pada segmen anterior, kejadian penolakan cangkok kornea (corneal graft) menjadi manifestasi segmen anterior yang paling umum pasca-vaksinasi COVID-19. 14,16 Gejala dan tanda khas penolakan cangkok kornea adalah onset akut penurunan penglihatan, kemerahan, fotofobia dengan atau tanpa rasa nyeri, edema kornea, lipatan Descemet, dan munculnya reaksi ruang anterior (anterior chamber).…”

“…14 Pada uvea, terdapat 2 temuan kasus, yaitu uveitis dan reaktivasi VKH (Vogt-Koyanagi-Harada Syndrome). 14 Pasien mengeluh muncul floater dan penurunan penglihatan yang berlangsung kurang dari 12 jam dan bersifat sementara, namun pada hari keempat pascavaksin pasien merasakan gejala yang sama tetapi lebih berat dari gejala awal pada hari pertama. 15 Kejadian ini diketahui lebih sering pada wanita dan sering pada orang yang mendapatkan dua vaksin atau lebih dalam sehari.…”

“…VAERS mencatat kejadian uveitis terjadi bukan hanya terkait vaksin COVID-19 saja, melainkan juga pada vaksin mRNA dan vektor virus secara umum; uveitis ini bersifat ringan dan mudah dikontrol dengan kortikosteroid topikal dan sikloplegik. 14,16 Kasus reaktivasi VKH setelah vaksinasi COVID-19 ditandai dengan onset akut khas kehilangan penglihatan bilateral tanpa rasa sakit, peradangan granulomatosa segmen anterior, dan ablasi retina eksudatif. Dua dari tiga kasus dialami oleh pengguna vaksin mRNA BNT162b2; semua kasus teratasi dengan baik menggunakan kortikosteroid sistemik.…”

“…Gejala lain termasuk paraparesis yang memburuk menjadi paraplegia, dengan tidak adanya refleks tendon tungkai, inkontinensia, dan defisit sensorik semua modalitas di bawah Th5. 14,20 Kasus lain adalah kelumpuhan saraf abdusen pada wanita berusia 59 tahun yang sebelumnya sehat, menderita diplopia horizontal dua hari setelah menerima vaksin mRNA COVID-19 BNT162b2.…”