Título

PAPILLOPHLEBITIS WITH CENTRAL RETINAL VEIN OCCLUSION FOLLOWING OXFORD/ASTRAZENECA COVID-19 VACCINATION

Objetivo

To report a case of papillophlebitis with central retinal vein occlusion following Oxford/AstraZeneca COVID-19 vaccination

Relato do Caso

A 45-year old woman was referred for ophthalmological evaluation due to a 1 month history of sudden onset of blurry vision and scotomas in her left eye 7 days after receiving the second dose of COVID-19 vaccine (ChAdOx1 nCoV-19, AZD1222- Oxford/AstraZeneca). Past ocular history was unremarkable. Past medical history was positive for pituitary adenoma, migraines and heterozygous mutation of methylenetetrahydrofolate reductase enzyme (MTHFR) diagnosed during previous fertility treatment. The best-corrected visual acuity (BCVA) was 20/20 in the right eye and 20/100 in the left eye. There was no afferent pupillary defect and anterior segment examination was normal in both eyes. Fundus examination was normal in the right eye, whereas in the left eye blurred borders of the optic head nerve, swelling and hyperemia, retinal venous tortuosity and vasodilation, peripapillary cotton wool spots, and intraretinal hemorrhages were observed. Screening for acute infections was negative. Anticardiolipin antibody IgG was undetermined, besides positive nuclear antibody factor. Anticoagulant therapy (Rivaroxaban) was started until additional investigation was completed. Further investigation for hypercoagulable disorders returned negative. A diagnosis of papillophlebitis with CRVO with a temporal association with AZ COVID-19 vaccine was made. Prednisone 40 mg/day was prescribed, followed by aflibercept intravitreal injection and dexamethasone intravitreal implant. Four months later, BCVA in the left eye evolved to 20/60, with partial improvement of retinal findings and macular edema.

Conclusão

Ocular manifestations may develop after receiving AZ COVID-19 vaccine. Even though the benefits of vaccination against COVID-19 outweigh the risks, ophthalmologists need to be aware of the emerging manifestations following mass immunization. This is the first case report of papillophlebitis with CRVO following AZ COVID-19 vaccination.