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. 2021 Dec 5;10(23):5705.
doi: 10.3390/jcm10235705.

Retinal Hemorrhage after SARS-CoV-2 Vaccination

Hyo Song Park  1 , Yeojue Byun  2 , Suk Ho Byeon  1 , Sung Soo Kim  1 , Yong Joon Kim  1 , Christopher Seungkyu Lee  1
Affiliations

Retinal Hemorrhage after SARS-CoV-2 Vaccination

Hyo Song Park et al. J Clin Med. .

Abstract

To report retinal vein occlusion (RVO) and age-related macular degeneration (AMD)-related submacular hemorrhage developing after administration of SARS-CoV-2 vaccines, a single-center, retrospective observational case series was conducted. Clinical data including fundus photographs and optical coherence tomography (OCT) scans were reviewed. Twenty-three eyes of 21 patients were included with the median age at symptom presentation being 77 years (range: 51-85 years). Twelve eyes (52.2%) had submacular hemorrhage and 11 (47.8%) had RVO. Twelve patients (60.9%) had been vaccinated with the Pfizer vaccine (BNT162b2) and 8 with the AstraZeneca (ChAdOx1) vaccine. Sixteen patients (76.2%) experienced ocular disease exacerbation after the first vaccination and 4 (19.0%) after the second vaccination. The median visual acuity (logarithm of the minimal angle of resolution; logMAR) before symptom development was 0.76 (interquartile range: 0.27-1.23); the median logMAR at symptom presentation was 1.40 (interquartile range 0.52-1.70). The median time between vaccination and symptom exacerbation was 2.0 days (interquartile range: 1.0-3.0 days). Five patients (23.8%) underwent tests for hematological abnormalities, including the presence of anti-PF4 antibodies; all were negative. Further studies with larger patient group for evaluation of effect of SARS-CoV-2 vaccination on retinal hemorrhage are necessary.

Keywords: BNT162b2; ChAdOx1 nCoV-19; SARS-CoV-2; retinal vein occlusion; submacular hemorrhage; vaccine.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Images of a patient with submacular hemorrhage and retinal vein occlusion (RVO) in both eyes (eyes 7 and 19). The patient developed submacular hemorrhage in the right eye and RVO in the left eye at 2 weeks after the first injection of BNT162b2. (A–D), Wide-field fundus photograph, OCT scan, fluorescein angiograph, and ICG angiograph of the right eye. OCT revealed subretinal hemorrhage. (E–H), Ultra-wide-field fundus photograph, OCT scan, fluorescein angiograph, and ICG angiograph of the left eye. Fluorescence angiography revealed blocked fluorescence at the site of retinal hemorrhage.
Figure 2
Figure 2
Images of representative eyes exhibiting submacular hemorrhage after vaccination. (A–D), Fundus photographs of eyes 1 and 2 before and after symptom exacerbation. This AMD patient developed subretinal hemorrhage in both eyes (A,B). Three days after the first dose of BNT162b2 and 1 week after photographs A and B were taken, the patient developed blurred vision, and fundus photographs taken on the following day revealed that the hemorrhage in both eyes had worsened (C,D). (E,F), Fundus photographs of eye 10 taken 4 weeks before and after symptom exacerbation. Two days after ChADOx1 vaccination, the patient experienced visual disturbance, and fundus photography revealed a new submacular hemorrhage. (G,H), Fundus and wide-angle fundus photographs of eye 4 taken 7 weeks before and after symptom exacerbation. The patient experienced reduced visual acuity 6 days after the first dose of BNT162b2; a massive submacular hemorrhage was evident.
Figure 3
Figure 3
Images of representative eyes exhibiting retinal vein occlusion (RVO) after vaccination. (A,B), Wide-field fundus photographs revealing branch RVO (eyes 14 and 21). (C,D), Wide-field fundus photographs revealing central RVO (eyes 23 and 17). (E,F), Wide-field fundus photographs of RVO with vitreous hemorrhage (eyes 22 and 13).
See this image and copyright information in PMC

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