Retinal occlusion after vaccination with vector, RNA, subunit and inactivated COVID-19 vaccines

A 13-year-old boy presented to the hospital with a complaint of painless diminution of vision in the left eye for 2 weeks. It started 15 days after taking the first dose of Corbevax COVID-19 vaccine. Corbevax, also known as BACOV2A, is a recombinant protein subunit vaccine approved for emergency use in India on 28 December 2021.

Fundus fluorescein angiography of the left eye showed a delay in venous filling in the early phase of angiogram and blocked fluorescence corresponding to the areas of hemorrhages revealed by fundus examination. 

The patient was administered three doses of pulse

corticosteroids followed by a tapering dose of oral corticosteroids. At 6 weeks follow-up, fundus revealed complete resolution of the retinal hemorrhages and disk edema.

A 44-year-old otherwise healthy male presented with sudden painless vision loss in his left eye 10 days after receiving inactivated vaccine Covaxin/BBV152. Fundus examination revealed arterial attenuation and macular cherry red spot, suggesting an acute central retinal artery occlusion (CRAO). Optical coherence tomography showed macular swelling and disorganization of the inner layers due to ischemic sequelae. The patient was kept on follow-up. 

A 76-year-old woman presented to the hospital complaining of painless vision loss in her left eye 48 hours after sthe first dose of the AstraZeneca COVID-19 vaccine. Her best-corrected visual acuity was only hand movement in the left eye. Left eye ophthalmologic examination showed the presence of arterial narrowing and a cherry red spot. Optical coherence tomography showed severe macular swelling of the inner retinal layers in the left eye Fluorescein angiography performed the following day confirmed the diagnosis. The cardiovascular examination including Holter ECG was unremarkable. Complete blood count was within normal limits, without thrombocytopenia. A subsequent cerebral CT and CT-angiography scans did not show any other acute vascular event. Doppler angiography of the carotid artery was performed and showed normal flow without clinically significant plaques, stenoses, occlusions or dissections.

14 more cases were reported in Italy.  Cases with retinal ischemic events and retinal detachments after application of the Pfizer, Moderna and Johnson & Johnson vaccines have been also recently reported.


REFERENCES

Nangia P, Prakash VJ, Majumder PD. Retinal venous occlusion in a child following Corbevax COVID-19 vaccination. Indian Journal of Ophthalmology. 2022 Oct 1;70(10):3713-5.

Thakar M, Bhattacharya S. Central retinal artery occlusion after vaccination with whole virion inactivated SARSCoV-2 vaccine Covaxin. Indian Journal of Ophthalmology. 2022 Oct 1;70(10):3716-9.

Abdin AD, Gärtner BC, Seitz B. Central retinal artery occlusion following COVID-19 vaccine administration. Am J Ophthalmol Case Rep. 2022 Jun;26:101430. doi: 10.1016/j.ajoc.2022.101430. Epub 2022 Feb 18. PMID: 35198832; PMCID: PMC8855623.

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