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Rapid Progression of Polypoidal Choroidal Vasculopathy following Third BNT162b2 mRNA Vaccination
Hirofumi Sasajima1, Masahiro Zako2, Rio Maeda1
1Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan.
Abstract:
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.
Insights
A rare case of rapid polypoidal choroidal vasculopathy (PCV) progression occurred after the third Pfizer-BioNTech mRNA vaccine dose. This case highlights a potential, though infrequent, association between mRNA COVID-19 vaccines and PCV worsening.
Area of Science:
- Ophthalmology
- Vaccinology
Background:
- Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration.
- The Pfizer-BioNTech (BNT162b2) mRNA vaccine is widely used for COVID-19 prevention.
Observation:
- A 79-year-old male experienced blurred vision 16 hours after his third BNT162b2 mRNA vaccine dose.
- Clinical examination revealed massive submacular hemorrhage (SMH) and subretinal fluid (SRF) due to PCV in the left eye.
- The patient had a history of diabetes, cataracts, nonproliferative diabetic retinopathy, glaucoma, and previous treatment for diabetic macular edema.
Findings:
- The patient underwent intravitreal bevacizumab injection, vitrectomy, and subretinal tissue plasminogen activator injection.
- Post-surgery, the SMH and SRF showed significant reduction within 13 days.
- This case suggests a possible, albeit rare, link between mRNA COVID-19 vaccination and PCV exacerbation.
Implications:
- Healthcare providers should be aware of potential rare ocular complications following mRNA vaccinations.
- Further research is needed to investigate the potential association between COVID-19 vaccines and PCV progression.
- Prompt diagnosis and management are crucial for patients presenting with vision changes post-vaccination.
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