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• W4386047562 abstract "Dear Sir, A 54-year-old Chinese man with no relevant past medical history presented to the emergency department with blurred vision of the left eye, which started 6 days ago. Notably, he had received his second dose of BNT162b2 (Pfizer-BioNTech) vaccine (BNT) 3 days before the onset of symptoms. On examination, best corrected visual acuities were 6/30 and 6/6 in the left and right eye, respectively. Slit-lamp examination revealed findings suggestive of a left central retinal vein occlusion (CRVO) with associated macular thickening [Figure 1a]. Fundus fluorescein angiography demonstrated leakage from inferior retinal veins with minimally delayed arteriovenous transit time and insignificant capillary fallout. No features suggestive of vasculitis were noted [Figure 1b]. The presence of cystoid macular oedema was confirmed on optical coherence tomography of the macula [Figure 1c]. These findings were consistent with a left nonischaemic CRVO complicated by cystoid macular oedema.Figure 1: (a) Ultra-widefield retinal imaging of the left eye demonstrates the presence of retinal haemorrhages, increased calibre and tortuosity of the retinal veins (yellow arrowhead), cotton wool spots, macular thickening, and optic disc swelling (white arrowhead). (b) Fundus fluorescein angiography of the left eye shows leakage predominantly from the optic disc (white arrowhead) and inferior retinal veins with minimal capillary fallout and lash artefacts (yellow arrowhead). These findings are consistent with a non-ischaemic retinal vein occlusion. (c) Macular optical coherence tomography performed six days after onset of retinal vein occlusion, shows extensive cystoid macular oedema (white arrowheads). (d) Macular optical coherence tomography performed at one-month follow-up after treatment with a single course of intravitreal Bevacizumab injection demonstrates improvement in macular oedema (white arrowhead).Further investigations, including workup for ischaemic risk factors and screening for an underlying prothrombotic state, were unremarkable. As no predisposing risk factors were identified in our patient despite extensive investigations and in view of his recent BNT vaccination, the suspicion of vaccination-induced CRVO was raised. Intravitreal injection of anti-vascular endothelial growth factor (bevacizumab 1.25 mg/0.05 mL) was administered to the left eye, which resulted in both structural improvement in macular oedema [Figure 1d] and visual acuity of the affected eye to 6/12 after a month. He received his second dose of intravitreal bevacizumab and was reviewed one month after the injection. Despite robust population-wide studies, our understanding regarding the safety profile of mRNA vaccines continues to evolve.[1] Indeed, anecdotal occurrences of retinal vein occlusion (RVO) following coronavirus disease 2019 (COVID-19) vaccinations have been reported. As of January 2022, the United Kingdom’s Yellow Card scheme has recorded 39, seven and 99 cases of RVO occurring in patients receiving BNT, mRNA-1273 (Moderna) and ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccines, respectively.[2] Side effects attributable to a proinflammatory state, such as acute macular neuroretinopathy and post-immunisation myocarditis, have also been reported.[3] Potential mechanisms for these include a molecular mimicry-based reaction initiated by the severe acute respiratory syndrome coronavirus 2 spike protein or a vaccine-incited, nonspecific innate immunological response.[3] While RVO might be another complication that clinicians need to be alerted to, larger surveillance studies are necessary to establish a true relationship. This report is limited to a single case, and hence, we are unable to establish causality of the vaccination event to the occurrence of RVO. As of January 2022, Singapore’s Health Science Authority reported a low rate of serious vaccination side effects (0.006%).[4] However, these events may result in long-term morbidity and even mortality.[1] Therefore, it is important for all healthcare practitioners to keep abreast with existing literature to identify patients experiencing potential complications of COVID-19 vaccinations, so that early and prompt interventions can be administered. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest." @default.
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• W4386047562 date "2023-08-22" @default.
• W4386047562 modified "2023-09-23" @default.
• W4386047562 title "Retinal vein occlusion following BNT162b2 (Pfizer-BioNTech) COVID-19 vaccination" @default.
• W4386047562 cites W3014553071 @default.
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• W4386047562 doi "https://doi.org/10.4103/singaporemedj.smj-2021-430" @default.
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