Physicians in New Delhi reported an uncommon case of bilateral immune-mediated keratolysis (corneal melting) after administration of 1 dose of the ChAdOx1 nCoV-19 (Covishield, AstraZeneca) vaccination.1
This case could indicate a temporal affiliation between this severe ocular antagonistic event after 1 dose of any of the accessible SARS-CoV-19 vaccines, according to first author Tanveer Alam Khan, MD, and colleagues from the Cornea, Cataract and Refractive Surgery Companies, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
The patient was a 48-year-old man who was introduced to the ophthalmic emergency division with what was described as progressive bilateral corneal melting 5 weeks after he acquired the primary dose of the COVID-19 vaccine.
The patient reported having experienced fever, diarrhea, and vomiting throughout the first 2 weeks following the vaccination, which then subsided before the ocular symptoms started 3 weeks after he acquired the vaccination.
Ocular examination confirmed a visible acuity of sunshine notion bilaterally with options of bilateral corneal melting with choroidal detachment on ultrasonography. Culturing was negative for microorganisms.
The patient underwent tectonic penetrating keratoplasty and the host corneal tissue was despatched for analysis that included histopathology, bacterial and fungal cultures, polymerase chain reaction for herpes simplex virus, varicella zoster virus, cytomegalovirus, adenovirus, and SARS-CoV-2.
“Microbial culture was sterile, and viral polymerase chain reaction reports were negative. Histopathological examination revealed dense inflammatory cell infiltration,” the investigators wrote.
In accordance with investigators, a detailed systemic workup revealed no underlying systemic or autoimmune pathology.
“Immune-mediated keratolysis after the ChAdOx1 nCoV-19 (Covishield) vaccination is an uncommon entity, and we believe that that this is the primary report of a temporal affiliation between a severe ocular antagonistic event after a single dose of any SARS-CoV-19 vaccine,” investigators concluded. “It could be included as a potential adverse event associated with this vaccine.”
Khan TA, Navneet S, Livia K, et al.* Bilateral immune-mediated keratolysis after immunization with SARS-CoV-2 recombinant viral vector vaccine. Cornea published online September 4, 2021; doi: 10.1097/ICO.0000000000002844