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Acute Corneal Transplant Rejection After COVID-19 Vaccination
Amar P Shah1, Daliya Dzhaber1, Kenneth R Kenyon2
1Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL.
Purpose:
The purpose of this report was to describe 4 cases of acute corneal transplant rejection occurring in association with coronavirus disease 2019 (COVID-19) mRNA vaccination.
Methods:
Four patients with prior keratoplasty developed presumed immunologic rejection after the mRNA-1273 vaccination for coronavirus 2 (SARS-CoV-2). Case 1 had received Descemet membrane endothelial keratoplasty 6 months ago and presented with endothelial graft rejection 3 weeks after the first vaccine dose. Case 2 had undergone penetrating keratoplasty 3 years previously and presented with acute endothelial rejection 9 days after the second vaccine dose. Case 3 had prior Descemet stripping automated endothelial keratoplasty (DSAEK) and began experiencing symptoms of endothelial graft rejection 2 weeks after the second vaccine dose. Case 4 presented with endothelial rejection of the penetrating keratoplasty graft 2 weeks after the second vaccine dose.
Results:
Frequent topical corticosteroids alone were initiated in all 4 cases. In case 1, the endothelial rejection line appeared fainter with improvement in visual acuity and corneal edema 5 weeks after diagnosis. Case 2 experienced complete resolution of corneal stromal edema and rejection line 6 weeks after diagnosis. Cases 3 and 4 have both experienced initial improvement with steroid treatment as well.
Conclusions:
These cases suggest acute corneal endothelial rejection may occur soon after either dose of the COVID-19 mRNA vaccine. Prompt initiation of aggressive topical steroid therapy may result in complete resolution of clinical signs and symptoms. Further studies are needed to elucidate the causal mechanism of corneal graft rejection after COVID-19 vaccination.
Insights
Acute corneal graft rejection can occur after COVID-19 mRNA vaccination. Prompt steroid treatment often resolves rejection symptoms, but further research is needed to understand the link between vaccination and corneal transplant rejection.
Area of Science:
- Ophthalmology
- Immunology
- Vaccinology
Background:
- Corneal transplantation is a common procedure to restore vision.
- The COVID-19 mRNA vaccines have been widely administered globally.
- Understanding potential side effects of vaccination is crucial for patient safety.
Observation:
- Four patients with prior corneal transplants experienced acute graft rejection following COVID-19 mRNA vaccination.
- Rejection episodes occurred within weeks of receiving the first or second vaccine dose.
- Symptoms included graft dysfunction and inflammation.
Findings:
- All four patients were treated with topical corticosteroids.
- Three out of four patients showed improvement or resolution of rejection signs with steroid therapy.
- One patient experienced initial improvement but required ongoing management.
Implications:
- COVID-19 mRNA vaccination may be associated with an increased risk of corneal transplant rejection.
- Early and aggressive steroid treatment appears effective in managing these rejection episodes.
- Further investigation is warranted to confirm causality and explore underlying mechanisms.
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