Dear Editor,
We read with interest the review by Sen et al.[1] titled “After the Storm: Ophthalmic Manifestations of COVID-19 Vaccines.” It was a comprehensive review of anterior and posterior segment manifestations as well as eyelid, orbital, and neuro-ophthalmological manifestations. We are particularly interested in the topic “Retinal vascular occlusions” under the subheading “Posterior Segment Manifestations of COVID-19 Vaccine,” where only retinal vein occlusion (RVO) was discussed, but no data on retinal artery occlusion (RAO) was available.
Although there were no cases of COVID-19-vaccine-related RAO published in Sen et al.’s[1] search period from January 1 to November 7, 2021, a few case reports and case series were published in the following half year.[2–6] Here, we would like to supplement Sen et al.’s[1] review on RAO after COVID-19 vaccine for completeness [Table 1]. Literature review by Su et al.[2] summarized COVID-19-vaccine-related RAO up to January 10, 2022. Two publications by Ikegami et al.[7] and Girbardt et al.[8] were included, both of which were reporting on mRNA SARS-CoV-2-vaccine-related retinal vascular occlusion events. Interestingly, both of these primary studies had a case of combined central RAO and RVO. Another case was published by Lee et al.[3] that was also associated with mRNA SARS-CoV-2 vaccine. More cases of branch RAO were subsequently published by Ishibashi et al.[5] and Kang et al.[6] who also reported its association with mRNA SARS-CoV-2 vaccine.
Table 1.
Summary of retinal artery occlusion cases following COVID-19 vaccinations
| Authors | Patient Age/ Gender | Comorbidities | Vaccine received | Diagnosis | Symptoms onset |
|---|---|---|---|---|---|
| Ikegami et al. (2021)[7] | 54/F | Hypothyroidism | 2 doses of mRNA-1273 Moderna (mRNA SARS-CoV-2) |
Right eye combined CRAO and CRVO | 2 days after 2nd dose |
| Girbardt et al. (2021)[8] | 38/M | Ankylosing spondylitis | 2 doses of Comirnaty BNT162b2 Pfizer-BioNTech (mRNA SARS-CoV-2) |
Right eye BRAO | 3 days after 2nd dose |
| Girbardt et al. (2021)[8] | 81/F | Arterial hypertension | 2 doses of Comirnaty BNT162b2 Pfizer-BioNTech (mRNA SARS-CoV-2) |
Right eye combined CRAO and CRVO | 12 days after 2nd dose |
| Lee et al. (2022)[3] | 34/M | Hyperlipidemia (newly diagnosed) | 2 doses of Comirnaty BNT162b2 Pfizer-BioNTech (mRNA SARS-CoV-2) |
Left eye combined CRAO and CRVO | 10-12 days after 2nd dose |
| Abdin et al. (2022)[4] | 76/F | Hypothyroidism | 1 dose of AstraZeneca (adenoviral vector-based SARS-CoV-2) | Left eye CRAO | 2 days |
| Ishibashi et al. (2022)[5] | 38/F | Nil | 1 dose of Comirnaty BNT162b2 Pfizer-BioNTech (mRNA SARS-CoV-2) |
Right eye BRAO | 15 days |
| Ishibashi et al. (2022)[5] | 80/M | Diabetes mellitus, hypertension | 2 doses of Comirnaty BNT162b2 Pfizer-BioNTech (mRNA SARS-CoV-2) |
Right eye BRAO | 42 days after 2nd dose |
| Ishibashi et al. (2022)[5] | 86/M | Hypertension | 2 doses of Comirnaty BNT162b2 Pfizer-BioNTech (mRNA SARS-CoV-2) |
Left eye BRAO | 4 days after 2nd dose |
| Ishibashi et al. (2022)[5] | 57/F | Nil | 2 doses of Comirnaty BNT162b2 Pfizer-BioNTech (mRNA SARS-CoV-2) |
Right eye BRAO | 61 days after 2nd dose |
| Kang et al. (2022)[6] | 64/M | Type 2 diabetes, hypertension | 1 dose of Comirnaty BNT162b2 Pfizer-BioNTech (mRNA SARS-CoV-2) |
Right eye BRAO | 3 days |
M, Male; F, Female; CRAO, Central retinal artery occlusion; CRVO, Central retinal vein occlusion; BRAO, Branch retinal artery occlusion; BRVO, Branch retinal vein occlusion; SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2
Although literature search yielded more cases of RAO after mRNA SARS-CoV-2 vaccine, the actual incidence of such was uncertain given the popularity of the mRNA vaccine all over the world. Proposed mechanisms for RAO post-COVID-19 vaccination include antigen-specific cell, molecular mimicry, and antibody-medicated hypersensitivity reactions. Up to mid-June 2022, there still have been no prospective studies showing the difference between RAO incidence across mRNA SARS-CoV-2 vaccine versus the viral vector vaccine.
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References
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