Ischemic retinal events after COVID-19 vaccination

Purpose: We report 2 cases of ischemic retinal events occurring soon after administration of the Moderna and Johnson & Johnson/Janssen COVID-19 vaccines. To our knowledge, these are the first reports of isolated ischemic retinal events occurring after COVID-19 vaccination. Observations: A 57-year-old female had new onset floaters of the left eye within days of her second Moderna COVID-19 vaccination, which progressively worsened prompting her to present for evaluation. She was diagnosed with a branch retinal vein occlusion in the left eye. A 20-year-old female presented with persistent central scotomata in both eyes, which she first noticed two days after her Johnson & Johnson/Jannsen COVID-19 vaccination. She was diagnosed with acute macular neuroretinopathy of both eyes. Conclusions and Importance: The potential side effects of COVID-19 vaccines are still being established; however, there has been concern over pro-thrombotic events with these vaccines, with most concerns directed toward the Johnson & Johnson vaccine. We observed likely transient pro-thrombotic retinal milieu in patients who received these vaccines though it remains unclear whether there is a shared mechanism between systemic response to the COVID-19 spike protein and the highly pro-thrombotic state seen in COVID-19 infections. In the case of our patients, we postulate their immunologic responses to the vaccines – and possibly a resultant pro-thrombotic state – may have precipitated their ischemic retinal events. We thus recommend that patients with ocular symptoms after COVID-19 vaccination undergo comprehensive ophthalmologic evaluation.