Neuroretinitis after the second injection of a SARS-CoV-2-vaccine: A case report

Abstract

Purpose: We report the first case of neuroretinitis after administration of a second dose of a messenger RNA vaccine for coronavirus disease-2019 (COVID-19).

Observations: An 83-year-old healthy woman presented with subacute, painless, and progressive visual loss in the right eye that started 2 days after the second injection of the COVID-19 vaccine (Comirnaty®) from Pfizer (New York, NY, USA) and BioNTech (Mainz, Germany). Visual acuities were hand motion perception in the right eye and 20/30 in the left eye. There was optic nerve head swelling in the right eye and subretinal fluid and disruption of the photoreceptor layers in both eyes. Magnetic resonance imaging revealed an enhancement of the right optic nerve, consistent with optic neuritis. She was treated with intravenous corticosteroids, and the optic nerve swelling in the right eye resolved promptly. However, the amount of subretinal fluid worsened for 1 month and did not improve until 6 months from onset. Her visual acuity was slightly improved to finger count perception in the right eye and 20/20 in the left eye during an examination 6 months from onset.

Conclusions and importance: Considering the temporal relation between the second dose of vaccination and the symptom onset in our patient, the ophthalmic symptoms here reported might be considered a rare adverse effect of the Comirnaty® COVID-19 vaccine. Although a causal relationship is not established, to our knowledge, this is the first report of neuroretinitis after vaccination with Comirnaty®, and any further similar cases should be examined in detail.

Keywords: Neuroretinitis; SARS-CoV-2-vaccine.

Fig. 1

Fundus photography (A: right eye, C: left eye) and optical coherence tomography (B: retinal nerve fiver layer thickness and significance map, D: macular cross-sectional image in the right eye, E: macular cross-sectional image in the left eye) revealed optic nerve head swelling in the right eye and subretinal fluid and disruption of the photoreceptor layers in both eyes. The Humphrey field analyzer showed a generalized field defect in the right eye (G) and superior arcuate scotoma in the left eye (F). Fluorescein angiography (H: right eye, I: left eye) showed multiple focal leakages from the retinal vessels without neovascularization at both early (upper images) and late (lower images) phases in both eyes.

Fig. 2

Magnetic resonance imaging (MRI) revealed discoid elevation and restricted diffusion in the right optic nerve head on the diffusion-weighted image (A). There was no significant signal change in the axial fat-suppressed T1-weighted image (B); however, the coronal multiplanar reconstruction image showed a subtle enhancement in the right optic nerve (C).

Fig. 3

Six months after the onset, fundus photography (A: right eye, B: left eye) showed mild pallor without swelling in the right optic nerve head. And subretinal fluid and disruption of the photoreceptor layers on optical coherence tomography (C: right eye, D: left eye) persisted stationary in both eyes. The Humphrey field analyzer showed a superior arcuate scotoma in the left eye (E) and generalized field defect in the right eye (F). Fluorescein angiography (G: right eye, H: left eye) showed a mild increase in focal leakages from the retinal vessels in both eyes.