International Medical Case Reports Journal (Apr 2022)
Acute Bilateral Descemet Membrane Endothelial Keratoplasty Graft Rejection After the BNT162b2 mRNA COVID-19 Vaccine
Abstract
Thomas Richard Johansen Forshaw,1 Christel Jørgensen,1 Maria Christiansen Kyhn,1 Javier Cabrerizo1– 3 1Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark; 2Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 3Department of Research, Copenhagen Eye Foundation, Copenhagen, DenmarkCorrespondence: Thomas Richard Johansen Forshaw, Department of Ophthalmology, Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, Glostrup, 2600, Denmark, Tel +45 38633863, Fax +45 38634689, Email [email protected]: We report a case of acute bilateral Descemet membrane endothelial keratoplasty (DMEK) rejection two weeks following BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech), reflecting on possible changes to the management of patients with DMEK scheduled for COVID-19 vaccination.Patients and Methods: A 94-year-old woman with Fuchs’ endothelial dystrophy who underwent DMEK 24 months earlier (right eye) and 20 months earlier (left eye) demonstrated bilateral graft rejection two weeks after the first dose of COVID-19 vaccine. Standard treatment regimen was followed, and clinical status documented with slit-lamp examination and swept-source optical coherence tomography throughout.Results: Preoperative best corrected visual acuity (BCVA) and corneal thickness (CT) were 0.3 and 679μm right eye and 0.2 and 668μm left eye. Postoperative BCVA and CT were 0.7 and 559μm right eye and 0.4 and 590μm left eye. Standard treatment regimen consisted of dexamethasone/tobramycin and ketorolac, four times daily. At one month, both preparations were discontinued, replaced by dexamethasone 0.1% four times daily. At three months, this was tapered to once daily. Post-rejection, BCVA and CT were 0.2 and 710μm right eye and 0.3 and 710μm left eye. Treatment was with dexamethasone/tobramycin six times daily. Poor response resulted in re-DMEK transplantation, starting in the left eye. At one-month follow-up, BCVA and CT were 0.5 and 538μm right eye and 0.63 and 504μm left eye.Conclusion: We report the first acute bilateral DMEK graft rejection after a single dose of COVID-19 vaccine. We recommend clinicians exercise vigilance and consider dexamethasone 0.1% during the vaccination period.Keywords: corneal transplant surgery, vaccination
