Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Jan 1;41(1):121-124.
doi: 10.1097/ICO.0000000000002878.

Acute Corneal Transplant Rejection After COVID-19 Vaccination

Amar P Shah  1 , Daliya Dzhaber  1 , Kenneth R Kenyon  2 , Kamran M Riaz  3 , Dean P Ouano  4 , Ellen H Koo  1
Affiliations
Case Reports

Acute Corneal Transplant Rejection After COVID-19 Vaccination

Amar P Shah et al. Cornea. .

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

PubMed Disclaimer

Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

References

    1. Johns Hopkins University & Medicine Coronavirus Resource Center. Available at: https://coronavirus.jhu.edu/ . Accessed April 12, 2021.
    1. Wertheim MS, Keel M, Cook SD, et al. Corneal transplant rejection following influenza vaccination. Br J Ophthalmol. 2006;90:925–926.
    1. Solomon A, Frucht-Pery J. Bilateral simultaneous corneal graft rejection after influenza vaccination. Am J Ophthalmol. 1996;121:708–709.
    1. Steinemann TL, Koffler BH, Jennings CD. Corneal allograft rejection following immunization. Am J Ophthalmol. 1988;106:575–578.
    1. Lockington D, Lee B, Jeng BH, et al. Survey of corneal surgeons' attitudes regarding keratoplasty rejection risk associated with vaccinations. Cornea. 2021 [epub ahead of print] doi: 10.1097/ICO.0000000000002662. - DOI

Publication types

Substances