Cornea and External Diseases, Moorfields Eye Hospital NHS Foundation Trust, London, UK
Cornea and External Diseases, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Br J Ophthalmol. 2021 Jul;105(7):893-896. doi: 10.1136/bjophthalmol-2021-319338. Epub 2021 Apr 28.
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.
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.
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.
我们报告了两例在接种 SARS-CoV-2 信使 RNA（mRNA）疫苗 BNT162b2 后发生内皮角膜同种异体移植排斥反应的病例，并描述了这对 COVID-19 后移植受者疫苗接种管理的影响。
一名 66 岁女性患有 Fuchs 内皮角膜营养不良（FECD）和单侧 Descemet 膜内皮角膜移植术（DMEK），在移植后 14 天接种了 COVID-19 mRNA 疫苗 BNT162b2。7 天后，她出现了内皮移植物排斥的症状和体征。一名 83 岁女性，双侧 FECD 3 年前和 6 年前接受了 DMEK 移植，在第二次接种 COVID-19 mRNA 疫苗 BNT162b2 后 3 周，双眼同时发生急性内皮排斥反应。两种情况下的排斥反应均通过局部皮质类固醇成功治疗。
我们认为这是首例报道 COVID-19 免疫接种后角膜移植排斥与任何免疫接种后 DMEK 排斥之间的时间关联，也是首例报道 DMEK 排斥与任何免疫接种之间的时间关联。我们假设同种异体反应可能是由宿主抗体反应在接种疫苗后引发的。临床医生和患者应意识到与疫苗接种相关的角膜移植排斥的潜在风险，并且可能希望在计划进行非紧急角膜移植术之前考虑接种疫苗。患者应接受咨询，了解需要紧急复查的症状和体征，以便及早治疗任何确诊的排斥发作。
