Forshaw Thomas Richard Johansen, Jørgensen Christel, Kyhn Maria Christiansen, Cabrerizo Javier
Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Int Med Case Rep J. 2022 Apr 14;15:201-204. doi: 10.2147/IMCRJ.S362698. eCollection 2022.
We report a case of acute bilateral Descemet membrane endothelial keratoplasty (DMEK) rejection two weeks following BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech), reflecting on possible changes to the management of patients with DMEK scheduled for COVID-19 vaccination.
A 94-year-old woman with Fuchs' endothelial dystrophy who underwent DMEK 24 months earlier (right eye) and 20 months earlier (left eye) demonstrated bilateral graft rejection two weeks after the first dose of COVID-19 vaccine. Standard treatment regimen was followed, and clinical status documented with slit-lamp examination and swept-source optical coherence tomography throughout.
Preoperative best corrected visual acuity (BCVA) and corneal thickness (CT) were 0.3 and 679µm right eye and 0.2 and 668µm left eye. Postoperative BCVA and CT were 0.7 and 559µm right eye and 0.4 and 590µm left eye. Standard treatment regimen consisted of dexamethasone/tobramycin and ketorolac, four times daily. At one month, both preparations were discontinued, replaced by dexamethasone 0.1% four times daily. At three months, this was tapered to once daily. Post-rejection, BCVA and CT were 0.2 and 710µm right eye and 0.3 and 710µm left eye. Treatment was with dexamethasone/tobramycin six times daily. Poor response resulted in re-DMEK transplantation, starting in the left eye. At one-month follow-up, BCVA and CT were 0.5 and 538µm right eye and 0.63 and 504µm left eye.
We report the first acute bilateral DMEK graft rejection after a single dose of COVID-19 vaccine. We recommend clinicians exercise vigilance and consider dexamethasone 0.1% during the vaccination period.
我们报告一例在接种BNT162b2 mRNA新冠疫苗（辉瑞-生物科技公司）两周后发生急性双侧Descemet膜内皮角膜移植术（DMEK）排斥反应的病例，并思考对于计划接种新冠疫苗的DMEK患者管理可能需要做出的改变。
一名94岁患有富克斯内皮营养不良的女性，分别于24个月前（右眼）和20个月前（左眼）接受了DMEK手术，在接种第一剂新冠疫苗两周后出现双侧移植片排斥反应。遵循标准治疗方案，全程通过裂隙灯检查和扫频光学相干断层扫描记录临床状态。
术前右眼最佳矫正视力（BCVA）和角膜厚度（CT）分别为0.3和679μm，左眼为0.2和668μm。术后右眼BCVA和CT分别为0.7和559μm，左眼为0.4和590μm。标准治疗方案包括地塞米松/妥布霉素和酮咯酸，每日四次。一个月时，两种制剂均停用，改为每日四次使用0.1%地塞米松。三个月时，用药逐渐减至每日一次。排斥反应后，右眼BCVA和CT分别为0.2和710μm，左眼为0.3和710μm。治疗为每日六次使用地塞米松/妥布霉素。因反应不佳，开始对左眼进行再次DMEK移植。在1个月随访时，右眼BCVA和CT分别为0.5和538μm，左眼为0.63和504μm。
我们报告了首例单剂新冠疫苗接种后发生的急性双侧DMEK移植片排斥反应。我们建议临床医生保持警惕，并在疫苗接种期间考虑使用0.1%地塞米松。
