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CENTRAL RETINAL VEIN OCCLUSION FOLLOWING BNT162B2 (PFIZER-BIONTECH) COVID-19 MESSENGER RNA VACCINE
Paras P Shah1, Samuel Gelnick2, Jonathan Jonisch2,3
1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
Insights
A rare case of central retinal vein occlusion occurred in a young woman following the first dose of the Pfizer-BioNTech COVID-19 vaccine. Symptoms worsened after the second dose, highlighting a potential immunological reaction.
Area of Science:
- Ophthalmology
- Vaccinology
- Public Health
Background:
- Coronavirus disease 2019 (COVID-19) vaccination has raised concerns about thromboembolic events.
- Ophthalmic manifestations post-vaccination are infrequently reported.
- Central retinal vein occlusion (CRVO) is a serious vascular condition affecting the eye.
Observation:
- A 27-year-old woman developed CRVO shortly after her first BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine dose.
- No primary risk factors for CRVO were identified through history or hypercoagulable workup.
- Ocular hemorrhages worsened after the second vaccine dose, indicating a potential adverse reaction.
Findings:
- The patient's CRVO improved with intravitreal ranibizumab injections.
- Multimodal imaging confirmed the diagnosis and monitored treatment response.
- The case suggests a possible link between COVID-19 vaccination and CRVO, potentially due to an immune response.
Implications:
- This case underscores the importance of monitoring for rare ophthalmic complications after COVID-19 vaccination.
- While rare, the severity of CRVO necessitates awareness among healthcare providers.
- The benefits of COVID-19 vaccination are substantial and should be weighed against the low risk of such adverse events.
Purpose:
Coronavirus disease 2019 has had a wide-ranging public health impact, contributing to at least five million deaths globally at the time of this report. Although thromboembolic events following coronavirus disease 2019 vaccination have been an ongoing concern, only a limited number of ophthalmic manifestations have been reported to date.
Methods:
A detailed history, hypercoagulable workup, best-corrected visual acuity (BCVA), Humphrey visual field, dilated fundus examination, and multimodal imaging including optical coherence tomography, fundus fluorescein angiography, and fundus photography were obtained.
Results:
A 27-year-old woman was diagnosed with central retinal vein occlusion a few days after her first dose of the BNT162b2 (Pfizer-BioNTech) coronavirus disease 2019 vaccine. Detailed elicitation of her history and a full hypercoagulable workup did not reveal any primary risk factors that could have explained her disease process. After the patient received the second dose, her symptoms deteriorated significantly and worsening peripapillary hemorrhage were seen on dilated fundus examination. The patient was treated with intravitreal injections of ranibizumab and followed closely, which showed improvement in her central retinal vein occlusion.
Conclusion:
Given the chronology of the patient's condition, it is believed that the central retinal vein occlusion that occurred as a result of the first dose was exacerbated by an intense immunological reaction after the second dose. The severity of this complication, despite its rarity, must be emphasized and weighed in but should not preclude the extensive benefits of vaccination.
