FEATURE EWAP MARCH 2023 15 by Ellen Stodola Editorial Co-Director How vaccines may affect the cornea T he push for widespread COVID-19 vaccination has renewed the focus on the side effects that vaccines may have. It’s an especially unique situation due to the distinct timeframe for this mass vaccination campaign. Clara Chan, MD, and Bennie H. Jeng, MD, spoke about potential ocular impacts of the vaccine and what physicians should look for. The concept of vaccine- induced corneal graft rejection, or any ocular inflammation, is not new, Dr. Jeng said. “Long ago, people wondered if a flu vaccine or any other vaccination can trigger an immune reaction,” he said. “It makes sense because the vaccination boosts your immune system, and your immune system gets revved up.” Previously, physicians were more likely to see random case reports, but it is appearing more now because of the worldwide push for a higher percentage of people to get COVID-19 vaccinations in a relatively short timeframe. “With a corneal graft, there is something antigenic in the eye, and the vaccination boosts the immune system, potentially causing the immune system to go after the transplant,” Dr. Jeng said. However, he said, “it can be very hard to prove causation in these cases.” Timing wise, if a patient has a graft that’s been doing fine for 6 years, they get the COVID-19 vaccine, and a few weeks later there is a rejection for the first time, that’s suspicious, Dr. Jeng said. While Dr. Jeng said he hasn’t experienced any of these cases in his practice, there have been multiple reports in the literature. “My patients ask me, because I think they have heard about the possibility, ‘Is it OK if I get the COVID-19 vaccination?’ My answer is ‘You should get it, and if it causes graft rejection, we can treat that and usually get you over it.’” There are some doctors who will start upping patients’ steroids for a couple of weeks before the vaccination and continue for a couple of weeks after, then bring them back down to potentially protect against any reaction. There are others like Dr. Jeng who will just have patients call immediately if there are any reactions after the vaccine. These reactions could include red eye, light sensitivity, pain, and decreased vision, among other symptoms. Dr. Jeng prefers the latter approach because adverse reactions are infrequent, so you may be overtreating 500 people to catch one. Additionally, most of the time if you treat after the fact, you can get patients through the episode with successful graft survival, he said. While you can’t always plan for when patients get their vaccine, Dr. Jeng said that if given the choice, he would recommend they get the vaccine before having a corneal transplant. If there is a chance that the vaccine could cause rejection, it’s potentially a lot of This article originally appeared in the December 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Contact information Chan: clarachanmd@gmail.com Jeng: bennie.jeng@pennmedicine.upenn.edu Left eye slit lamp photo of patient with moderate limbal stem cell deficiency (note whorl pattern of “late” fluorescein staining) and best corrected Snellen vision of 20/50.
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