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Review
. 2022 Jul 1;33(4):296-305.
doi: 10.1097/ICU.0000000000000855.

Impact of vaccination on keratoplasty

Sarah P Dugan  1 , Shahzad I Mian
Affiliations
Review

Impact of vaccination on keratoplasty

Sarah P Dugan et al. Curr Opin Ophthalmol. .

Abstract

Purpose of review: Corneal graft rejection has been reported after coronavirus disease 2019 (COVID-19) vaccination. The purpose of this review is to evaluate the literature regarding corneal graft rejection after vaccination, including rejection rates and risk factors. We aim to create a framework to identify patients who are at higher risk for graft rejection and may warrant consideration of prophylactic interventions.

Recent findings: Graft rejection has been reported following administration of mRNA, viral vector, and inactivated whole-virion COVID-19 vaccines. Most cases had additional risk factors associated with rejection. Vaccination increases circulation of proinflammatory cytokines, CD4+ and CD8+ T-cell responses, and antispike neutralizing antibody, all of which may contribute to graft rejection. Two prospective studies have found no relationship between recent vaccination and rejection but 20% of cornea specialists report to have seen a vaccine-associated rejection and 22% recommend delaying vaccination in certain circumstances. Many specialists recommend prophylactic topical corticosteroids before and after vaccination to mitigate rejection risk but there is no evidence to support this practice on a wider scale.

Summary: Our framework identified 96.8% of penetrating keratoplasty patients with vaccine-associated rejection as higher risk. Further research is needed in order to develop evidence-based guidelines.

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References

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    1. Keye P, Lapp T, Böhringer D, et al. Clinical course of different types of immune reactions following keratoplasty. Klin Monbl Augenheilkd 2021.
    1. Phylactou M, Li J-PO, Larkin DFP. Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine. Brit J Ophthalmol 2021; 105:893–896.
    1. Vignapiano R, Vicchio L, Favuzza E, et al. Corneal graft rejection after yellow fever vaccine: a case report. Ocul Immunol Inflamm 2021. 1–4. [Epub ahead of print].
    1. Hamilton A, Massera R, Maloof A. Stromal rejection in a deep anterior lamellar keratoplasty following influenza vaccination. Clin Exp Ophthalmol 2015; 43:838–839.

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