Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine

AimWe report two cases of endothelial corneal allograft rejection following immunisation with SARS-CoV-2 messenger RNA (mRNA) vaccine BNT162b2 and describe the implications for management of transplant recipients postvaccination for COVID-19.MethodsA 66-year-old woman with Fuchs endothelial corneal dystrophy (FECD) and a unilateral Descemet’s membrane endothelial keratoplasty (DMEK) transplant received COVID-19 mRNA vaccine BNT162b2 14 days post-transplant. Seven days later, she presented with symptoms and signs of endothelial graft rejection. An 83-year-old woman with bilateral DMEK transplants for FECD 3 and 6 years earlier developed simultaneous acute endothelial rejection in both eyes, 3 weeks post second dose of COVID-19 mRNA vaccine BNT162b2. Rejection in both cases was treated successfully with topical corticosteroids.ConclusionsWe believe this is the first report of temporal association between corneal transplant rejection following immunisation against COVID-19 and the first report of DMEK rejection following any immunisation. We hypothesise that the allogeneic response may have been initiated by the host antibody response following vaccination. Clinicians and patients should be aware of the potential of corneal graft rejection associated with vaccine administration and may wish to consider vaccination in advance of planned non-urgent keratoplasties. Patients should be counselled on the symptoms and signs that require urgent review to allow early treatment of any confirmed rejection episode.

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Acute corneal graft rejection after anti-severe acute respiratory syndrome-coronavirus-2 vaccination: A report of four cases

European Journal of Ophthalmology ◽

10.1177/11206721211064033 ◽

2021 ◽

pp. 112067212110640

Author(s):

Miltiadis Balidis ◽

Dimitrios Mikropoulos ◽

Zisis Gatzioufas ◽

Penelope B de Politis ◽

Georgios Sidiropoulos ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Graft Rejection ◽

Messenger Rna ◽

Acute Onset ◽

Corneal Graft ◽

Corneal Transplant ◽

Transplant Patients ◽

Causative Relationship ◽

Corneal Graft Rejection ◽

Causative Effect

Purpose This study intends to add to previous reports on acute corneal graft rejection following anti-severe acute respiratory syndrome-coronavirus-2 vaccination, providing data to corroborate a possible causative relationship between anti-COVID-19 immunization and corneal graft rejection, regardless of vaccine or graft type. Methods and Results This report describes 4 cases of acute-onset rejection as early as 5 days following the first dose of anti-severe acute respiratory syndrome-coronavirus-2 vaccine types not yet referred for corneal allograft. Patients were individually given the Moderna messenger RNA-1273 COVID-19 vaccine (2 patients) and the AstraZeneca COVID-19 vaccine, Vaxzevria, AZD1222 (2 patients). Conclusions Even though a direct causative effect is hard to prove, temporal proximity between anti-severe acute respiratory syndrome-coronavirus-2 vaccines of different types and consecutive reports of corneal graft rejection indicates the need for further investigation. Consistent advice must be given to corneal transplant patients regarding such risk.

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Prediction of corneal graft rejection using central endothelium/Descemet’s membrane complex thickness in high-risk corneal transplants

Scientific Reports ◽

10.1038/s41598-021-93892-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Taher Eleiwa ◽

Amr Elsawy ◽

Eyup Ozcan ◽

Collin Chase ◽

William Feuer ◽

...

Keyword(s):

High Risk ◽

Clinical Diagnosis ◽

Graft Rejection ◽

Repeated Measures ◽

Corneal Thickness ◽

Corneal Graft ◽

Corneal Transplant ◽

Corneal Graft Rejection ◽

Corneal Transplants

AbstractTo determine whether measurements of Endothelium/Descemet complex thickness (En/DMT) are of predictive value for corneal graft rejection after high-risk corneal transplantation, we conducted this prospective, single-center, observational case series including sixty eyes (60 patients) at high risk for corneal graft rejection (GR) because of previous immunologic graft failure or having at least two quadrants of stromal vascularization. Patients underwent corneal transplant. At 1st, 3rd, 6th, 9th, and 12th postoperative month, HD-OCT imaging of the cornea was performed, and the corneal status was determined clinically at each visit by a masked cornea specialist. Custom-built segmentation tomography algorithm was used to measure the central En/DMT. Relationships between baseline factors and En/DMT were explored. Time dependent covariate Cox survival regression was used to assess the effect of post-operative En/DMT changes during follow up. A longitudinal repeated measures model was used to assess the relationship between En/DMT and graft status. Outcome measures included graft rejection, central Endothelium/Descemet’s complex thickness, and central corneal thickness (CCT). In patients with GR (35%), the central En/DMT increased significantly 5.3 months (95% CI: 2, 11) prior to the clinical diagnosis of GR, while it remained stable in patients without GR. During the 1-year follow up, the rejected grafts have higher mean pre-rejection En/DMTs (p = 0.01), compared to CCTs (p = 0.7). For En/DMT ≥ 18 µm cut-off (at any pre-rejection visit), the Cox proportional hazard ratio was 6.89 (95% CI: 2.03, 23.4; p = 0.002), and it increased to 9.91 (95% CI: 3.32, 29.6; p < 0.001) with a ≥ 19 µm cut-off. In high-risk corneal transplants, the increase in En/DMT allowed predicting rejection prior to the clinical diagnosis.

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Analysis of causes and outcomes of corneal transplantation in al-zahra eye hospital in southeast of Iran from 2011-2016

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172598 ◽

2017 ◽

Vol 5 (7) ◽

pp. 2917

Author(s):

Behrouz Dehghan ◽

Mohammadnaeem Aminifard ◽

Zahra Raisi

Keyword(s):

Transplant Rejection ◽

Corneal Transplantation ◽

Organ Transplant ◽

Corneal Opacity ◽

Corneal Dystrophy ◽

Bullous Keratopathy ◽

Corneal Transplant ◽

Term Care ◽

Corneal Scar

Background: Corneal transplantation is known as the most successful and common type of organ transplant, but it calls for more intensive and long-term care. Given the lack of adequate information on this important surgery in this province and the differences between indications and causes of corneal transplantation, the present research was carried out to examine the causes and outcomes of corneal transplant in patients visiting Al-Zahra eye hospital who had received donated cornea in the past five years.Methods: In a retrospective analytical-descriptive study 135 files of 149 eyes that had gone through corneal transplantation were examined. Information on the age, gender, residence, indications, and surgery consequences was extracted and was analyzed in SPSS 19 statistical software with descriptive statistics (percentage, frequency, mean, and standard deviation.Results: The highest transplant indication was keratoconus with a frequency of 39.9% followed by bullous keratopathy, corneal opacity, and transplant rejection with frequencies of 16.1, 12.7, and 10.1%, respectively. Other indications were corneal scar (9.4%), corneal perforation (2.7%), trauma (2.7%), and Fuchs’ corneal dystrophy (1.3%) in the order mentioned. Concerning postoperative complications in this research, 57.7% of the eyes (86 cases) showed no complication. Moreover, complications were mostly related to astigmatism with a frequency of 30.8% (46 cases).Conclusions: In general, the most common indication in this research was keratoconus. Most surgeries were also complication-free and most complications were associated with astigmatism.

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Prognostic and preventive role of various factors in corneal rejection after keratoplasty

Fyodorov journal of ophthalmic surgery ◽

10.25276/0235-4160-2021-1-82-87 ◽

2021 ◽

pp. 82-87

Author(s):

S.N. Sakhnov ◽

◽

V.V. Myasnikova ◽

A.O. Martsinkevich ◽

K.I. Melkonyan ◽

...

Keyword(s):

Risk Factors ◽

Transplant Rejection ◽

Current Data ◽

Corneal Transplant ◽

Timely Manner ◽

Pathogenetic Mechanisms ◽

Corneal Graft Rejection ◽

Key Words Cornea ◽

Preventive Role

The literature review is devoted to the analysis of modern publications on the immunological and pathogenetic mechanisms of transplanted corneal rejection, risk factors, predictors and methods of the prevention of this complication. The prevention of corneal rejection is challenging. Currently, there is no single algorithm for the predicting methods of the corneal graft rejection, so further research in this area is needed. Purpose. To assemble the current data on immunological and non-immunological predictors of postoperative complications after keratoplasty. The analysis of modern publications on the immunological and pathogenetic mechanisms of corneal transplant rejection, risk factors, predictors and methods of prevention of this complication is presented. The databases used were CyberLeninka, PubMed, and Medline. The focus was on the publications of the last 10 years. Conclusion. The data presented in the review make it possible to identify signs of corneal transplant rejection and to determine treatment in a timely manner, as well as to implement methods for preventing these complications. Key words: cornea, keratoplasty, keratograft, rejection, cytokines, ocular immune privilege.

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