Acute corneal graft rejection after anti-severe acute respiratory syndrome-coronavirus-2 vaccination: A report of four cases

European Journal of Ophthalmology (EJO)
2021 Nov 26;11206721211064033
PMID: 34825599
doi: 10.1177/11206721211064033

Miltiadis Balidis1, Dimitrios Mikropoulos2, Zisis Gatzioufas3, Penelope Burle de Politis1, Georgios Sidiropoulos1, Vassilios Vassiliadis1

1Ophthalmica Eye Institute, Thessaloniki, Greece
2Department of Ophthalmology, Faculty of Medicine, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
3Department of Ophthalmology, University Hospital Basel, Basel, Switzerland



This study intends to add to previous reports on acute corneal graft rejection following anti-severe acute respiratory syndrome-coronavirus-2 vaccination, providing data to corroborate a possible causative relationship between anti-COVID-19 immunization and corneal graft rejection, regardless of vaccine or graft type.

Methods and results

This report describes 4 cases of acute-onset rejection as early as 5 days following the first dose of anti-severe acute respiratory syndrome-coronavirus-2 vaccine types not yet referred for corneal allograft. Patients were individually given the Moderna messenger RNA-1273 COVID-19 vaccine (2 patients) and the AstraZeneca COVID-19 vaccine, Vaxzevria, AZD1222 (2 patients).


Even though a direct causative effect is hard to prove, temporal proximity between anti-severe acute respiratory syndrome-coronavirus-2 vaccines of different types and consecutive reports of corneal graft rejection indicates the need for further investigation. Consistent advice must be given to corneal transplant patients regarding such risk.


COVID-19; Cornea; anti-severe acute respiratory syndrome-coronavirus-2; graft; rejection; vaccination.

Source: Pubmed

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