Corneal Transplant Graft Rejection Following Immunization With Sars-Cov-2 Mrna Vaccine Bnt162b2 (Pfizer- Biontech): A Case Series

Published 2022 - 40th Congress of the ESCRS

Reference: PO020 | Type: Case report | DOI: 10.82333/ym3x-0m75

Authors: Abdulrahman Alotaibi* ¹ , Abdullah Al-Kaabi ¹ , Julia Talajic ² , Johanna Choremis ¹

¹Ophthalmology,McGill University,Montréal,Canada, ²Ophthalmology,Universite de Montreal ,Montréal,Canada

We report two cases of corneal graft rejection following the administration of the SARS-CoV-2vaccine BNT162b2 (Pfizer-BioNTech) in the setting of two different types of keratoplasties: Descemet’smembrane endothelial keratoplasty (DMEK) and penetrating keratoplasty (PK). Thus, increasing the awareness of possible graft rejection after vaccination to take the necessary steps to prevent corneal graft rejection after vaccination.

Department of Ophthalmology, McGill University, Canada

Department of Ophthalmology, Université de Montréal, Canada

The first case is of a 66-year-old man with a right PK (performed for herpes simplex virus-related corneal scar) with a stable post-operative period. He presented 16 months post-op with signs and symptoms of an acute corneal graft rejection starting 2 weeks after his first-dose vaccination with the BNT16b2 vaccine (Pfizer-BioNTech). His best corrective visual acuity (BCVA) was 20/100 and intraocular pressure (IOP) of 20 mmHg. On slit lamp exam of his right eye, he had conjunctival injection, corneal graft edema, endothelial keratic precipitates (KPs), and an anterior chamber reaction of +1 cells/ high power field (HPF).

The second case is a 73-year-old woman post left eye DMEK (performed 4 years previously for Fuch's Endothelial Corneal Dystrophy (FECD)) presented with an acute episode of endothelial graft rejection 2 weeks following first-dose vaccination with the BNT16b2 vaccine (Pfizer-BioNTech). Her BCVA of the left eye was 20/30 and her examination showed signs of graft rejection similar to the first case. Both patients were started on hourly prednisolone acetate 1% drops and showed significant improvement to their baseline BCVA.

The introduction of messenger RNA (mRNA) vaccines against the SARS-CoV-2 virus has been a turning point in the global response to the coronavirus-19 pandemic. They have been shown to significantly reduce morbidity and mortality associated with this coronavirus disease. The increased immunity has an added risk of graft failure in patients with corneal transplants. This should not defer patients with corneal grafts from vaccination, however, it is important for ophthalmologists to be aware of this risk. Our recommendation is to increase the frequency of topical steroids to four times a day (QID) a few days before getting the vaccine and for up to one month post-vaccination to avoid vaccine related corneal graft rejection.