This article is about corneal graft rejection among those who received COVID-19 shots.
The cornea is the transparent front part of the eye. It is in front of the pupils, the iris, and the lens.
The eyes have immune privilege. That means they can tolerate antigens from foreign bodies (i.e., corneal grafts) without eliciting an immune response that manifests as transplant rejection.
According to Hori et al., immune privilege makes human corneal transplantation successful. A 2000 article from the British Medical Journal reported that corneal graft survival was 90% at one year, 74% at five years, and 62% at seven years.
In July 2022, the Journal of Clinical Medicine published a systematic review, Characteristics and Clinical Ocular Manifestations in Patients with Acute Corneal Graft Rejection after Receiving the COVID-19 Vaccine: A Systematic Review.
The authors described 21 patients (23 eyes) with acute corneal graft rejection after COVID-19 vaccination.
The types of transplantation that had rejection included penetrating keratoplasty (12 eyes), Descemet membrane endothelial keratoplasty (six eyes), Descemet stripping automated endothelial keratoplasty (four eyes), and living-related conjunctival-limbal allograft (one eye).
The vaccines involved were BNT162b2 (Pfizer/BioNTech) in eight cases. mRNA-1273 (Moderna) in eight cases, ChAdOx1 (AstraZeneca) in four cases and CoronaVac (Sinovac Biotech) in one case.
Approximately 66.7% of these patients received the first vaccine dose, whereas 33.3% received the second vaccine dose.
The interval between vaccination and rejection ranged from 1 day to 6 weeks. More than 95% of eyes (22/23 eyes) had corneal allograft rejection within three weeks from vaccination.
Corneal edema was the leading clinical manifestation (20 eyes), followed by keratic precipitates (14 eyes) and redness of the eyes (14 eyes).
Keratic precipitates are inflammation that manifests as white deposits in the cornea.
Medications to save the grafts included frequently applied topical corticosteroids (12 eyes), followed by a combination of topical and oral corticosteroids (four eyes).
Nine eyes (39.1%, 9/23) developed corneal graft failure after vaccination, even with attempts to save the grafts.
It is noteworthy that nine of the 23 eyes in this study had undergone more than one transplantation. Recurrent infections, autoimmune disease, and multiple corneal transplantations can eliminate the immune privilege of the anterior eye, according to the authors.
Parting thoughts
This study is significant because the White House is backing an annual COVID-19 booster, and most Americans plan to get them. We may see more corneal graft rejections in the future.
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Reference:
Fujio K et al. Characteristics and Clinical Ocular Manifestations in Patients with Acute Corneal Graft Rejection after Receiving the COVID-19 Vaccine: A Systematic Review. J. Clin. Med. 2022, 11(15), 4500
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