Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ..

AIM: We report two cases of endothelial corneal allograft rejection following immunisation with SARS-CoV-2 messenger RNA (mRNA) vaccine BNT162b2 and describe the implications for management of transplant recipients postvaccination for COVID-19.

METHODS: A 66-year-old woman with Fuchs endothelial corneal dystrophy (FECD) and a unilateral Descemet's membrane endothelial keratoplasty (DMEK) transplant received COVID-19 mRNA vaccine BNT162b2 14 days post-transplant. Seven days later, she presented with symptoms and signs of endothelial graft rejection. An 83-year-old woman with bilateral DMEK transplants for FECD 3 and 6 years earlier developed simultaneous acute endothelial rejection in both eyes, 3 weeks post second dose of COVID-19 mRNA vaccine BNT162b2. Rejection in both cases was treated successfully with topical corticosteroids.

CONCLUSIONS: We believe this is the first report of temporal association between corneal transplant rejection following immunisation against COVID-19 and the first report of DMEK rejection following any immunisation. We hypothesise that the allogeneic response may have been initiated by the host antibody response following vaccination. Clinicians and patients should be aware of the potential of corneal graft rejection associated with vaccine administration and may wish to consider vaccination in advance of planned non-urgent keratoplasties. Patients should be counselled on the symptoms and signs that require urgent review to allow early treatment of any confirmed rejection episode.

Media Type:

Electronic Article

Year of Publication:

2021

Contained In:

The British journal of ophthalmology - Vol. 105, No. 7 (2021), p. 893-896

Language:

English

Contributors:

Phylactou, Maria
Li, Ji-Peng Olivia
Larkin, Daniel F P

Links:

Volltext

Keywords:

*Descemet Stripping Endothelial Keratoplasty
7S5I7G3JQL
Administration, Ophthalmic
Aged
Aged, 80 and over
Allografts
Anterior Eye Segment
BNT162 vaccine
COVID-19
COVID-19 Vaccines
Case Reports
Cornea
Dexamethasone
Endothelium, Corneal
Female
Fuchs' Endothelial Dystrophy
Glucocorticoids
Graft Rejection
Humans
Immunization
Immunology
Intraocular Pressure
Journal Article
Microscopy, Confocal
N38TVC63NU
Ophthalmic Solutions
RNA, Messenger
SARS-CoV-2
Slit Lamp Microscopy
Tomography, Optical Coherence
Visual Acuity

Notes:

Date Completed 05.07.2021

Date Revised 05.07.2021

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1136/bjophthalmol-2021-319338

PMID:

33910885

PPN (Catalogue-ID):

NLM325752656