CENTRAL RETINAL VEIN OCCLUSION FOLLOWING BNT162B2 (PFIZER-BIONTECH) COVID-19 MESSENGER RNA VACCINE.

ABSTRACT

PURPOSE: Coronavirus disease 2019 has had a wide-ranging public health impact, contributing to at least five million deaths globally at the time of this report. Although thromboembolic events following coronavirus disease 2019 vaccination have been an ongoing concern, only a limited number of ophthalmic manifestations have been reported to date. METHODS: A detailed history, hypercoagulable workup, best-corrected visual acuity (BCVA), Humphrey visual field, dilated fundus examination, and multimodal imaging including optical coherence tomography, fundus fluorescein angiography, and fundus photography were obtained. RESULTS: A 27-year-old woman was diagnosed with central retinal vein occlusion a few days after her first dose of the BNT162b2 (Pfizer-BioNTech) coronavirus disease 2019 vaccine. Detailed elicitation of her history and a full hypercoagulable workup did not reveal any primary risk factors that could have explained her disease process. After the patient received the second dose, her symptoms deteriorated significantly and worsening peripapillary hemorrhage were seen on dilated fundus examination. The patient was treated with intravitreal injections of ranibizumab and followed closely, which showed improvement in her central retinal vein occlusion. CONCLUSION: Given the chronology of the patient's condition, it is believed that the central retinal vein occlusion that occurred as a result of the first dose was exacerbated by an intense immunological reaction after the second dose. The severity of this complication, despite its rarity, must be emphasized and weighed in but should not preclude the extensive benefits of vaccination.