Unilateral macular branch retinal vein occlusion in a healthy Indian woman following coronavirus disease vaccination: a case report and comprehensive literature review
Medical hypothesis, discovery & innovation in optometry,
Vol. 4 No. 2 (2023),
22 June 2023
,
Page 95-101
https://doi.org/10.51329/mehdioptometry178
Abstract
Background: The coronavirus disease (COVID-19) vaccines exert ocular adverse effects, including episcleritis, scleritis, anterior and recurrent uveitis, acute macular neuroretinopathy, paracentral acute middle maculopathy, ophthalmic vein thrombosis, Graves’ disease, arteritic anterior ischemic optic neuropathy, non-arteritic anterior ischemic optic neuropathy, central serous chorioretinopathy, Vogt-Koyanagi-Harada disease, multifocal choroiditis, cranial nerve palsies such as facial or abducens nerve palsy, acute zonal occult outer retinopathy, acute zoster ophthalmicus following re-activation of the varicella-zoster virus, acute retinal necrosis, and multiple evanescent white dot syndrome. In this case report, we explored the possibility of macular branch retinal vein occlusion and its association with COVID-19 vaccination.Case Presentation: A 44-year-old healthy woman presented with unilateral nonprogressive blurring of vision in the right eye (OD). Her best-corrected distance visual acuity (BCDVA) in OD was 20 / 40. The anterior-segment evaluation was normal. Fundus evaluation of the OD revealed macular branch vein occlusion. She had a history of COVID-19 vaccination within 1 month. The interleukin-6 level was elevated six folds to 30.5 pg / mL. However, COVID-19 immunoglobulin G (IgG) antibodies were negative. Infective etiologies, such as tuberculosis and dengue, were ruled out. Spectral-domain optical coherence tomography (SD-OCT) of the OD showed hyperreflective dots in the posterior vitreous, inner retinal swelling, and cystoid changes in the macula. The maximum central macular thickness was 486 mm. A single dose of bevacizumab was administered at OD intravitreally. At the final follow-up 2.5 months later, her BCDVA had improved to 20 / 20 OD. Fundus evaluation revealed fewer retinal hemorrhages and cotton wool spots. SD-OCT of the OD showed a normal foveal contour and absence of cystoid spaces. Her maximum central macular thickness was 236 mm.
Conclusions: A temporal effect of vein occlusion secondary to COVISHIELD™ vaccination may occur in the absence of systemic risk factors. The interleukin-6 level was elevated, and the remaining blood test results were within normal limits. Since this is a case report, it is limited by the absence of strong evidence to prove this causal relationship between macular branch retinal vein occlusion and the specific brand of COVID-19 vaccination.
- COVID-19 virus vaccines
- ChAdOx1 nCoV 19
- Covishield
- macula luteas
- retinal branch vein occlusion
- cystoid macular edema
- avastin
- intravitreal injection
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