LAUSR

Central retinal vein occlusion (CRVO) and other thromboembolic events have been extensively documented after infections with SARS-Cov2 [1, 2]. We observed a 50-year-old healthy nonobese and nonsmoking patient with CRVO occurring immediately after the 2nd vaccination with an mRNA-based vaccine. Immediately after the second COVID19 vaccination (BioNTech/Pfizer lot number EP6017 expiry 30/06/2021) on 20/03/2021, during the 15 min mandatory surveillance with monitoring of vital signs the patient experienced retrobulbar pain, red eye and vision reduction on his left eye. He was referred and e-consulted externally and prescribed moxifloxacin eye drops. At presentation on 11/04/2021, BSCVA was OU 1.0/0.5 due to a hemorrhagic CRVO with ischemic areas (Fig. 1a). The fellow eye was unremarkable. The OCT showed a cystoid macular edema (central retinal thickness (CRT) 515my) (Fig. 1b), mild papilledema (prominence 809my), the ZeissHumphrey VF30-2 an inferonasal coecoceal visual field defect (MD 5.43 dB) and the fluorescein angiography vascular staining and mild macular leakage. The patient was PCR negative for SARSCov2 and healthy except for atopic dermatitis on topical treatment. No history of myocardial infarction and stroke was known, blood pressure was 121/76 mmHg (11/04/2021) and the HbA1c 5.1% (11/04/2021). The thrombophilia panel and CBC including platelet count were unremarkable, and d-Dimer was not elevated (0.3 mg/l). Antithrombotic treatment of 100 mg/d low-dose acetylsalicylic acid was accompanied by monthly and ongoing aflibercept injections starting on 12/04/2021, which resulted in a fast decrease of the macular edema with recovery of vision to BSCVA 1.0/1.0 already after 3 days (CRT 319my) (Fig. 2a,b). Anticoagulants (e.g., factor Xa inhibitor) used in COVID19-associated deep vein thrombosis were not administered. A wide range of thromboembolic events after COVD19 vaccinations with adenovirus vector-based vaccines has been reported and has been associated with systemic inflammation, platelet and endothelial dysfunction [3, 4], however, ophthalmic adverse events seem to be rare [5]. The CRVO immediately following the 2 vaccination with an mRNA-based vaccine in an otherwise healthy patient suggests that thromboembolic events may not only occur in vectorbased but also in mRNA-based vaccines. The pathophysiology and the role of atopy in this case are currently unknown, and causality may be revealed in future studies. A. A. Bialasiewicz (&) M. S. Farah-Diab H. T. Mebarki Dept. of Ophthalmology, Al-Ahli Hospital, Doha, Qatar e-mail: [email protected]