Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL.
Cornea Service, New England Eye Center, Tufts University School of Medicine, Boston, MA.
Cornea. 2022 Jan 1;41(1):121-124. doi: 10.1097/ICO.0000000000002878.
The purpose of this report was to describe 4 cases of acute corneal transplant rejection occurring in association with coronavirus disease 2019 (COVID-19) mRNA vaccination.
Four patients with prior keratoplasty developed presumed immunologic rejection after the mRNA-1273 vaccination for coronavirus 2 (SARS-CoV-2). Case 1 had received Descemet membrane endothelial keratoplasty 6 months ago and presented with endothelial graft rejection 3 weeks after the first vaccine dose. Case 2 had undergone penetrating keratoplasty 3 years previously and presented with acute endothelial rejection 9 days after the second vaccine dose. Case 3 had prior Descemet stripping automated endothelial keratoplasty (DSAEK) and began experiencing symptoms of endothelial graft rejection 2 weeks after the second vaccine dose. Case 4 presented with endothelial rejection of the penetrating keratoplasty graft 2 weeks after the second vaccine dose.
Frequent topical corticosteroids alone were initiated in all 4 cases. In case 1, the endothelial rejection line appeared fainter with improvement in visual acuity and corneal edema 5 weeks after diagnosis. Case 2 experienced complete resolution of corneal stromal edema and rejection line 6 weeks after diagnosis. Cases 3 and 4 have both experienced initial improvement with steroid treatment as well.
These cases suggest acute corneal endothelial rejection may occur soon after either dose of the COVID-19 mRNA vaccine. Prompt initiation of aggressive topical steroid therapy may result in complete resolution of clinical signs and symptoms. Further studies are needed to elucidate the causal mechanism of corneal graft rejection after COVID-19 vaccination.
本报告旨在描述 4 例与 2019 年冠状病毒病（COVID-19）mRNA 疫苗接种相关的急性角膜移植排斥反应病例。
4 例先前接受过角膜移植的患者在接种 COVID-19 mRNA-1273 疫苗后出现疑似免疫排斥反应。病例 1 在 6 个月前接受了后弹力层内皮角膜移植术，在第一剂疫苗后 3 周出现内皮移植物排斥反应。病例 2 在 3 年前接受了穿透性角膜移植术，在第二剂疫苗后 9 天出现急性内皮排斥反应。病例 3 先前进行过撕囊自动化内皮角膜移植术（DSAEK），在第二剂疫苗后 2 周开始出现内皮移植物排斥反应的症状。病例 4 在第二剂疫苗后 2 周出现穿透性角膜移植排斥反应。
在所有 4 例患者中，均单独频繁使用局部皮质类固醇治疗。在病例 1 中，在诊断后 5 周，内皮排斥线变得更淡，视力和角膜水肿得到改善。病例 2 在诊断后 6 周，角膜基质水肿和排斥线完全消退。病例 3 和病例 4 经类固醇治疗后也都有了初步改善。
这些病例提示 COVID-19 mRNA 疫苗接种后任何一剂疫苗后不久都可能发生急性角膜内皮排斥反应。及时开始积极的局部皮质类固醇治疗可能会导致临床体征和症状完全消退。需要进一步的研究来阐明 COVID-19 疫苗接种后角膜移植排斥的因果机制。
