Corneal Graft Endothelial Rejection in Association with COVID-19 Vaccine

A patient with history of pseudophakic bullous keratopathy (PBK) of the right eye (OD) was self-referred to cornea service for progressively decreasing vision. He subsequently underwent uncomplicated Descemet’s membrane endothelial keratoplasty (DMEK) OD. He then presented for routine follow up six months after DMEK with decreased vision OD x 1 week. Examination revealed VA 20/60, increased stromal edema, and an endothelial rejection. Pachymetry worsened to 743 microns. Patient had received his 1st dose of the Moderna COVID-19 vaccine 2.5 weeks prior to symptom onset. Topical steroids were increased to q2hours with initial improvement in vision and pachymetry. He went on to receive his 2nd COVID vaccine. Five weeks after the second dose, he had further worsening of vision, corneal edema, and pachymetry necessitating a sub-tenon’s injection of triamcinolone. Four weeks later, VA improved to 20/40 and pachymetry returned to 623 microns. Topical steroids were subsequently gradually tapered.

Presentation Date: 05/20/2021

Issue Date: 06/04/2021