Dear Editor,
We went through the article titled “Retinal venous occlusion in a child following Corbevax COVID-19 vaccination” by Nangia et al.[1] This is an interesting case report and the case has been managed well. We have a few queries for the authors. The patient presented with complaints of loss of vision in his left eye. Fundus fluorescein angiography of the affected eye does not show any signs of macular ischemia. The authors have not provided with any optical coherence tomography images. It will be good to know the cause of vision loss in this patient in the absence of macular ischemia. Was there macular edema in this case, which was the probable cause of vision loss in the affected eye? The authors postulate post-vaccination inflammation as the probable cause of vascular occlusion. It will be enlightening for the readers to know if any signs of inflammatory vascular occlusion like vitreous cells, vascular sheathing, etc., were present in this case. A battery of tests has been performed in this case. It has not been mentioned if tests for systemic inflammation like erythrocyte sedimentation rate, C-reactive protein, interleukin-6, etc., have been performed. These inflammatory markers can be elevated in patients with systemic inflammation, and raised levels of these markers could have supported the hypothesis postulated by the authors.
It has also not been mentioned if serum homocysteine levels were estimated in this case. Raised serum homocysteine levels can be an independent risk factor associated with retinal venous occlusive disease.[2] Central retinal vein occlusion associated with raised serum homocysteine levels has previously been reported in the literature.[3] Probable causes of thrombosis induced by hyperhomocysteinemia include endothelial toxicity, promotion of smooth muscle proliferation, intimal thickening, increased platelet adhesion, activation of factor V, and decreased production of nitric oxide and prostacyclin.[4] Hyperhomocysteinemia should be ruled out in this case first before considering the vaccine as the potential cause of vascular occlusion.
This patient developed ocular symptoms following the first dose of vaccine. Two doses of the Corbevax vaccine with a one-month interval between the two doses is the vaccination schedule currently being followed in India. Our last query for the authors is that since they consider the vaccine as the possible cause of venous occlusion, should the second dose of the vaccine be delayed?
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References
- 1.Nangia P, Prakash VJ, Dutta Majumder P. Retinal venous occlusion in a child following Corbevax COVID-19 vaccination. Indian J Ophthalmol. 2022;70:3713–5. doi: 10.4103/ijo.IJO_1927_22. [DOI] [PMC free article] [PubMed] [Google Scholar]
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