Abstract
Purpose :
To evaluate the cases of retinal artery and vein occlusion (RAO/RVO) following SARS-CoV-2 vaccination & assess the clinical presentations in patients.
Methods :
A retrospective analysis of cases reported to the Centers for Disease Control and Prevention (CDC) Vaccine Adverse Events Reporting System (VAERS) between December 11, 2020 & July 1, 2022. Patients diagnosed with RAO and RVO occlusion following vaccination with BNT162b2(Pfizer-BioNTech), mRNA-1273(Moderna) & Ad26.Cov2.S(Janssen). We performed a descriptive analysis of patient demographics, history & ophthalmic and systemic clinical presentations. The correlation between vaccine type & continuous variables was performed using the one-way ANOVA test. We used Pearson’s chi-square test to assess the association between three vaccines & categorical variables. A post-hoc analysis was performed between RAO & RVO onset intervals following vaccination, dose & vaccine type. The 30-day risk analysis was also performed for RAO & RVO onset post-vaccination using reverse Kaplan-Meier analysis.
Results :
A total of 1250 cases of RVO (817, 65.36%) & RAO (433, 34.64%) were reported. The mean age of patients with RVO & RAO was 58.54±16.06 and 64.63±16.16 years, respectively. Most of the cases of RVO (606, 74.17%) and RAO (324, 74.83%) were reported in patients who received BNT162b2. In the cohort, 48.47 & 47.81% diagnosed with RVO & RAO were women. About a third of RVO(34.88%) & RAO(37.18%) cases were reported after the first dose. More than half of the cases of RVO (54.09%) & RAO (57.97%) were reported in the first 2-weeks following vaccination. The estimated crude reporting rate (per million doses) in the United States was 0.46, 0.35 & 0.91 for BNT162b2, mRNA-1273 & Ad26.COV2.S, respectively. The onset interval for RVO was significantly shorter in patients who received BNT162b2 (18.07±28.66 days, p<0.0001) compared to mRNA-1273 (22.85±38.13 days) & Ad26.Cov2.S (54.07±88.98 days) vaccines. The 30-day risk analysis showed a significantly higher risk of RVO following BNT162b2 than the other two vaccines (p=0.049).
Conclusions :
The low crude reporting rate suggests that RVO & RAO following SARS-CoV-2 vaccination occur rarely. This study provides insights into the possible temporal association between reported RVO & RAO following SARS-CoV-2 vaccines. Further studies are required to delineate the possible immunological mechanisms that cause RAO/RVO following vaccination.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.