Five Cases of Corneal Graft Rejection After Recent COVID-19 Vaccinations and a Review of the Literature

Abstract

The purpose of this study was to report 5 cases of acute corneal graft rejection after COVID-19 vaccination and perform a review of the literature.Methods: This was a case series and review of literature dated on the October 10, 2021. Results:We describe 5 cases-2 patients with Descemet stripping automated endothelial keratoplasty (for Fuchs endothelial dystrophy) who presented with acute corneal graft rejection after their first dose of mRNA (BNT162) vaccine. The other 3 patients who had penetrating keratoplasty performed more than 10 years ago for keratoconus presented with acute graft rejection-2 patients after their second dose of adenovirus vector (AZD1222) vaccine and 1 patient after first dose of mRNA (BNT162) vaccine. Three patients were not using any topical steroid treatment at the time of diagnosis of graft rejection. The mean duration between vaccination and onset of symptoms was 16.86 6 6.96 days for the mRNA vaccine and 17 6 11.89 days for the adenovirus vector vaccine. Conclusions: Corneal graft rejection has recently been reportedafter COVID-19 vaccination. Patients with keratoplasty need to be advised regarding the risk of corneal graft rejection and warning symptoms of rejection after COVID-19 vaccination. Seeking early referral to the emergency department and increasing topical steroids pre-COVID-19 and post-COVID-19 vaccination may reduce the risk of rejection.

Solid Organ Rejection following SARS-CoV-2 Vaccination or COVID-19 Infection: A Systematic Review and Meta-Analysis

“…Cells in the anterior chamber There were 42 case reports [5][6][7][8][11][12][13]17,18,[20][21][22][24][25][26][27][29][30][31][32][33][34][35][37][38][39][40][41][42][43][44][45][48][49][50][51][52][53][54][55][56][57], 8 case series [9,10,14,28,36,46,47,58] and 2 cohort studies [19,23]. These studies were conducted in t...…”

Acute corneal allograft rejection following SARS‐CoV‐2 vaccination–A systematic review

“…Fourteen eyes (38.9%) had received at least one previous allograft (Balidis et al, 2021 ; Dhillon et al, 2017 ; Gouvea et al, 2022 ; Molero‐Senosiain et al, 2022 ; Parmar et al, 2021 ; Phylactou et al, 2021 ; Rajagopal & Priyanka, 2022 ; Rallis et al, 2021 ; Shah et al, 2022 ; Simão & Kwitko, 2022 ; Wasser et al, 2021 ; Yu et al, 2022 ) including redo PKP (6 eyes), (Balidis et al, 2021 ; Parmar et al, 2021 ; Simão & Kwitko, 2022 ; Wasser et al, 2021 ; Yu et al, 2022 ) PKP after limbal or sclerokeratoplasty grafts (2 eyes), (Gouvea et al, 2022 ; Shah et al, 2022 ) redo EK (4 eyes), (Balidis et al, 2021 ; Molero‐Senosiain et al, 2022 ; Phylactou et al, 2021 ) and PKP after failed EK (2 eyes). (Rajagopal & Priyanka, 2022 ; Rallis et al, 2021 ) Two eyes had more than 3 corneal grafts (Molero‐Senosiain et al, 2022 ; Simão & Kwitko, 2022 ) and four eyes (11.1%) had a history of previous rejection episodes (Abousy et al, 2021 ; Balidis et al, 2021 ; Molero‐Senosiain et al, 2022 ; Simão & Kwitko, 2022 ).…”

“…Resolution of rejection signs on the allograft (anatomical resolution) was reported in 28 eyes (77.8%), with five eyes (13.9%) evolving to allograft failure and three eyes (8.3%) showing partial anatomical improvement. When functional resolution was considered (based on improvement of BCVA to at least 50% of the BCVA before the acute allograft rejection episode), the rate of partial resolution increased to 11.1% due to one case reported by Molero‐Senosiain et al in which BCVA before rejection was 0.52 logMAR and final BCVA after anatomical resolution was 0.80 logMAR (Molero‐Senosiain et al, 2022 ). Management strategies and outcomes of acute corneal allograft rejection following SARS‐CoV‐2 vaccination are presented in Tables 3 and 4 .…”

“…Management strategies included starting topical corticosteroids (CS) or increasing the frequency of topical CS in all cases. The most frequently prescribed topical CS was dexamethasone 0.1% (13 cases), followed by prednisolone acetate 1% (6 cases), betamethasone 0.1% (4 cases), and difluprednate 0.05% (3 cases); the type of topical CS was not described in 7 cases (Molero‐Senosiain et al, 2022 ; Phylactou et al, 2021 ; Rajagopal & Priyanka, 2022 ; Yu et al, 2022 ). Some corneal surgeons also added oral CS (de la Presa et al, 2022 ; Fujimoto & Kiryu, 2021 ; Molero‐Senosiain et al, 2022 ; Parmar et al, 2021 ; Rajagopal & Priyanka, 2022 ; Wasser et al, 2021 ) and/or subconjunctival or intracameral CS to the treatment regime (Balidis et al, 2021 ).…”

COVID-19 Vaccination Induced Corneal Graft Rejection Does Not Exist: Results of a Large Multi-country Population Based Study

“…Since the inception of various nation-based vaccination programmes, ophthalmologists have identi ed and sought to publish cases of corneal transplant rejection with a temporal association to the SARS-CoV-2 vaccine and many such case reports have been published to date. [4][5][6][7][8][9][10][11][12][13][14][15][16] However, case reports are low level evidence which can be subject to observer, reporting and publication bias. As physicians, we have the duty to offer our patients sound medical advice based on the best available evidence and to not unnecessarily contribute to vaccine hesitancy, if unwarranted.…”