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

Br J Ophthalmol. 2021 Jul;105(7):893-896. doi: 10.1136/bjophthalmol-2021-319338. Epub 2021 Apr 28.

Abstract

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.

Keywords: COVID-19; cornea; immunology.

Publication types

  • Case Reports

MeSH terms

  • Administration, Ophthalmic
  • Aged
  • Aged, 80 and over
  • Allografts
  • Anterior Eye Segment / diagnostic imaging
  • BNT162 Vaccine
  • COVID-19 / genetics
  • COVID-19 / prevention & control*
  • COVID-19 Vaccines / adverse effects*
  • Descemet Stripping Endothelial Keratoplasty*
  • Dexamethasone / therapeutic use
  • Endothelium, Corneal / diagnostic imaging
  • Endothelium, Corneal / pathology*
  • Female
  • Fuchs' Endothelial Dystrophy / surgery
  • Glucocorticoids / therapeutic use
  • Graft Rejection / diagnostic imaging
  • Graft Rejection / drug therapy
  • Graft Rejection / etiology*
  • Humans
  • Immunization / adverse effects*
  • Intraocular Pressure / physiology
  • Microscopy, Confocal
  • Ophthalmic Solutions
  • RNA, Messenger / genetics
  • SARS-CoV-2 / genetics
  • Slit Lamp Microscopy
  • Tomography, Optical Coherence
  • Visual Acuity / physiology

Substances

  • COVID-19 Vaccines
  • Glucocorticoids
  • Ophthalmic Solutions
  • RNA, Messenger
  • Dexamethasone
  • BNT162 Vaccine