新冠肺炎或新冠肺炎疫苗接种后视网膜动脉和静脉阻塞风险。

Retinal Artery and Vein Occlusion Risks after Coronavirus Disease 2019 or Coronavirus Disease 2019 Vaccination.

机构信息

Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, South Korea; Department of Ophthalmology, Soonchunhyang University Hospital Bucheon, Bucheon, South Korea.

Department of Computer Science and Engineering, Sungkyunkwan University, Suwon, South Korea.

出版信息

Ophthalmology. 2024 Mar;131(3):322-332. doi: 10.1016/j.ophtha.2023.09.019. Epub 2023 Sep 20.

DOI:10.1016/j.ophtha.2023.09.019

PMID:37739232

Abstract

PURPOSE

To evaluate the incidence of new retinal artery occlusion (RAO) and retinal vein occlusion (RVO) after the diagnosis of coronavirus disease 2019 (COVID-19) or vaccination against COVID-19 and compare the incidences with the population with neither.

DESIGN

Nationwide population-based cohort study.

PARTICIPANTS

From a nationwide population-based cohort, 8 418 590 patients were categorized into control (group 1), COVID-19 infection (group 2), and COVID-19 vaccination (group 3) groups.

METHODS

The cumulative incidence of RAO and RVO was calculated in groups 1, 2, and 3 using the Kaplan-Meier method. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) based on the Poisson distribution for RAO and RVO according to each group and subgroup using Cox proportional hazards models, with group 1 as the reference. We conducted univariable and multivariable analyses for the risk factors of RAO and RVO according to each subgroup.

MAIN OUTCOME MEASURES

Cumulative incidence and risks of incidence of RAO and RVO from the index date to day 60.

RESULTS

In multivariable analysis, no significant increase in RAO and RVO risks after COVID-19 or COVID-19 vaccination were observed in either men or women. These results were observed consistently across various conditions in sensitivity analyses. In subgroup analysis, individuals who were vaccinated before infection showed no significant increase in RAO or RVO risks in both sexes compared with the control group. In the subgroup analysis of vaccinated patients, the HRs of RAO and RVO for different vaccine types did not show an increase compared with the control group; however, an exception was observed in women who received mRNA-1273 vaccines, who showed a higher RAO HR (4.65; 95% CI, 1.27-17.03; P = 0.021).

CONCLUSIONS

Within 60 days of COVID-19 diagnosis or vaccination, RAO and RVO occurred rarely. We observed no increase in the HR of RVO and RAO relative to COVID-19 or COVID-19 vaccination except for a possible increase in the RAO HR in women who received mRNA-1273, for which the raw incidence was extremely low. Further investigation is required to validate this result.

FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

摘要

目的

评估在诊断为 2019 年冠状病毒病（COVID-19）或接种 COVID-19 疫苗后新发视网膜动脉阻塞（RAO）和视网膜静脉阻塞（RVO）的发生率，并与既无 COVID-19 感染也无 COVID-19 疫苗接种的人群进行比较。

设计

全国基于人群的队列研究。

参与者

从全国基于人群的队列中，将 8418590 名患者分为对照组（第 1 组）、COVID-19 感染组（第 2 组）和 COVID-19 疫苗接种组（第 3 组）。

方法

使用 Kaplan-Meier 法计算第 1、2 和 3 组中 RAO 和 RVO 的累积发生率。我们使用泊松分布基于 Cox 比例风险模型根据每个组和亚组计算 RAO 和 RVO 的风险比（HR）和 95%置信区间（CI），并以第 1 组为参照。我们根据每个亚组进行了 RAO 和 RVO 风险的单变量和多变量分析。

主要观察指标

从指数日期到第 60 天的 RAO 和 RVO 的累积发生率和发病风险。

结果

多变量分析显示，男性和女性 COVID-19 或 COVID-19 疫苗接种后 RAO 和 RVO 的发病风险均无显著增加。在敏感性分析中，这些结果在各种情况下均一致。在亚组分析中，与对照组相比，感染前接种疫苗的个体在两性中 RAO 或 RVO 的发病风险均无显著增加。在接种疫苗患者的亚组分析中，不同疫苗类型的 RAO 和 RVO 的 HR 与对照组相比没有增加；然而，女性接种 mRNA-1273 疫苗的 RAO HR 较高，为 4.65（95%CI，1.27-17.03；P=0.021），这是一个例外。

结论

在 COVID-19 诊断或接种疫苗后 60 天内，RAO 和 RVO 很少发生。除了接受 mRNA-1273 的女性 RAO HR 可能升高外（原始发病率极低），我们观察到 COVID-19 或 COVID-19 疫苗接种与 RVO 和 RAO 的 HR 没有增加，而接受 mRNA-1273 的女性 RAO HR 可能升高。需要进一步调查来验证这一结果。