A report published in Cornea describes four cases of acute corneal transplant rejection occurring in association with coronavirus disease 2019 (COVID-19) mRNA vaccination.
Tell me more.
Four patients with prior keratoplasty developed presumed immunologic rejection after the mRNA-1273 vaccination for coronavirus 2 (SARS-CoV-2). The first patient received Descemet membrane endothelial keratoplasty 6 months prior and presented with endothelial graft rejection 3 weeks after the first vaccination dose. The second patient underwent penetrating keratoplasty 3 years previously and presented with acute endothelial rejection 9 days after the second vaccination dose. The third patient had previous Descemet stripping automated endothelial keratoplasty and began experiencing symptoms of endothelial graft rejection 2 weeks after the second vaccine dose. The fourth patient presented with endothelial rejection of the penetrating keratoplasty graft 2 weeks after the second vaccine dose.
What did they find?
Frequent topical corticosteroids alone were initiated in all four cases. In the first case, the endothelial rejection line appeared fainter, with improvement in visual acuity and corneal edema 5 weeks after diagnosis. The second patient experienced complete resolution of corneal stromal edema and rejection line 6 weeks after diagnosis. The third and fourth patients also experienced initial improvement with steroid treatment.
According to the authors of the report, these cases suggest that acute corneal endothelial rejection may occur soon after either dose of the COVID-19 mRNA vaccine.