key: cord-0935372-weq5v3do
authors: Goyal, Mallika; Murthy, Somasheila I; Srinivas, Yadavalli
title: Unilateral retinal vein occlusion in a young, healthy male following Sputnik V vaccination
date: 2021-12-03
journal: Indian J Ophthalmol
DOI: 10.4103/ijo.ijo_2412_21
sha: e732a5f8e37eca83ad95f758a081ef5c6e14e542
doc_id: 935372
cord_uid: weq5v3do

nan

Dear Editor, While ocular arterial and venous thromboembolic events have been frequently reported following COVID-19 infection, [1] there are fewer reports of these occurring after vaccination. [2] We report a 28-year-old healthy male with visual deterioration in his right eye 11 days after receiving the second dose of the Gam-COVID-Vac/Sputnik V (Gamaleya Institute).

At presentation, the best-corrected visual acuity (BCVA) in right eye was 6/9, N8. There were no anterior or posterior segment signs of inflammation. The intraocular pressures and pupillary responses were normal. Fundus examination revealed superior hemi-retinal vein occlusion with severe cystoid macular edema while the left eye was unremarkable [ Fig. 1a-d] . The patient underwent a comprehensive examination by our internist and his vital parameters were normal. Complete hemogram, blood sugars, serum lipid profile, serum thyroid profile, serum homocysteine, anti-nuclear antibody, anti-neutrophil cytoplasmic antibodies (C and P), serum calcium, serum angiotensin-converting enzyme (ACE), Treponema pallidum hemagglutination assay, serum HIV test, chest X-ray, d-Dimer, coagulation profile, and COVID-19 antibodies were unremarkable. Serum IgG COVID-19 antibodies were strongly positive (Spike-S1 neutralizing antibodies by chemiluminescent microparticle immunoassay method) at 2946.4 arbitrary units (AU) per milliliter (positive threshold: 50 AU/mL; as a reference COVID-19 infection is associated with serum antibody levels of 112.40 AU/ml at 3 weeks after infection [3] ). Oral prednisolone 40 mg daily was prescribed in tapering doses and the anticoagulant drug apixaban 2.5 mg twice daily was advised for six weeks. Three days later, the VA improved to 6/6, N6 and the macula showed decreased edema [ Fig. 2a Sy st emic art erial and venous t hromb oemb olic events have been extensively reported following other adenoviral vector-based vaccines such as ChAdOx1 CoV-19 (AstraZeneca, University of Oxford, and Covishield, Serum Institute of India) [4] and Ad26.COV2.S vaccine (Janssen, Johnson and Johnson). [5] Central retinal vein occlusion has been reported to occur after the second dose of the m-RNA SARS-CoV-2 vaccine (Pfizer-BioNTech, USA). [2] However, so far, neither ocular nor systemic thromboembolic events have been reported following the SPUTNIK V vaccine and we believe this to be the first such report of ocular venous occlusion. The exact pathophysiology is uncertain especially as there were no preexisting risk factors in our case.

In conclusion, we reemphasize that vaccination is the most promising approach for containing the COVID-19 pandemic. There is broad consensus among regulatory agencies and expert panels that the benefits of vaccination greatly outweigh the potential risks of rare vaccine side effects. While retinal arterial and vein occlusions are probably extremely rare, based on the paucity of reports, in view of the long-lasting impact on the vision, patients should be gently cautioned to report immediately in case of any visual side effects.

Funding was provided by Hyderabad Eye Research Foundation, Hyderabad, India for Dr. Somasheila I. Murthy. The funders had no role in the preparation, review, or approval of the manuscript.

There are no conflicts of interest.

Departments 

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Central retinal vein occlusion occurring immediately after 2 nd dose of mRNA SARS-CoV-2 vaccine

Profile of specific antibodies to SARS-CoV-2: The first report

Arterial events, venous thromboembolism, thrombocytopenia, and bleeding after vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: population based cohort study

CDC Health Alert Network. Cases of cerebral venous sinus thrombosis with thrombocytopenia after receipt of the Johnson and Johnson COVID-19 vaccine

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