Paracentral acute middle maculopathy progressing to central retinal artery occlusion following coronavirus disease vaccination: a multimodal imaging report

S. Sanjay, S. Sharief, Santosh Gopikrishna Gadde, Poornachandra B Gowda
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Abstract

Background: Coronavirus disease (COVID-19) vaccines can cause adverse ocular effects, including vascular insults, acute macular neuroretinopathy, paracentral acute middle maculopathy (PAMM), ophthalmic vein thrombosis, Graves’ disease, arteritic anterior ischemic optic neuropathy (A-AION), and nonarteritic AION. Here, we report a case of unilateral PAMM progressing to central retinal artery occlusion (CRAO) after COVID-19 vaccination, identified using multimodal imaging. Case Presentation: A 24-year-old healthy man presented with unilateral progressive blurring of vision in the right eye. He had a recent history of fever without rashes 2 weeks after coronavirus disease vaccination. He was diagnosed with PAMM in the right eye at a local hospital and treated with a tapering dose of oral steroids. At presentation, he showed progressive blurring of vision in the right eye and the best-corrected distance visual acuity (BCDVA) was 20/60. The anterior segment was normal. Fundus examination revealed a pale optic disc with arteriolar attenuation and barrage laser scarring at the inferotemporal periphery. CRAO was diagnosed based on the right eye findings. The patient underwent multimodal imaging, including wide-field fundus photography using Optos® (Optos Carfornia®, Optos Inc., Dunfermline, United Kingdom), multicolor imaging with Spectralis™ (Heidelberg Retinal Angiograph; Heidelberg Engineering, Inc., Dossenheim, Germany), fundus fluorescence angiography (Heidelberg Retinal Angiograph; Heidelberg Engineering, Inc., Dossenheim, Germany), and optical coherence tomography angiography (ANGIOVUE, OPTOVUE, Inc., Fremont, CA, USA) using the split-spectrum amplitude-decorrelation angiography algorithm. The condition progressed from PAMM to CRAO during the oral steroid treatment course. At the 2-month follow-up, the right eye BCDVA had improved to 20/50, with fundus findings remaining the same as at the previous visit. Conclusions: This was the first report of a young patient with PAMM presenting with focal vascular occlusion that evolved to global occlusion in the form of CRAO in the absence of systemic vascular risk factors and with a normal coagulation profile. This case suggests that arterial occlusion may exert a temporary effect secondary to COVISHIELD™ vaccination. Randomized controlled trials and case – control studies on the role of vaccination in precipitating thromboembolic events in healthy individuals would provide insight into the causation.
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冠状病毒疫苗接种后,中央旁急性中黄斑病变进展为视网膜中央动脉闭塞:一份多模式成像报告
背景:冠状病毒病(COVID-19)疫苗可引起眼部不良反应,包括血管损伤、急性黄斑神经视网膜病变、中央旁急性中黄斑病变(PAMM)、眼静脉血栓形成、Graves病、动脉前缺血性视神经病变(A-AION)和非动脉性AION。在这里,我们报告一例单侧PAMM在COVID-19疫苗接种后进展为视网膜中央动脉闭塞(CRAO),使用多模态成像识别。病例介绍:24岁健康男性,右眼单侧进行性视力模糊。他在冠状病毒疫苗接种后2周有近期发热史,无皮疹。他在当地一家医院被诊断为右眼PAMM,并接受了逐渐减少剂量的口服类固醇治疗。就诊时,患者右眼视力进行性模糊,最佳矫正距离视力(BCDVA)为20/60。前节正常。眼底检查显示浅色视盘伴小动脉衰减和颞下周围的弹幕激光疤痕。cro是根据右眼的检查结果诊断的。患者接受了多模态成像,包括使用Optos®(Optos california®,Optos Inc., Dunfermline,英国)的广角眼底摄影,使用Spectralis™(海德堡视网膜血管造影;Heidelberg Engineering, Inc., dosenheim, Germany),眼底荧光血管造影(Heidelberg Retinal Angiograph;Heidelberg Engineering, Inc., dosenheim, Germany)和光学相干断层扫描血管造影(ANGIOVUE, OPTOVUE, Inc., Fremont, CA, USA),使用分谱幅度去相关血管造影算法。在口服类固醇治疗过程中,病情由PAMM发展为CRAO。在2个月的随访中,右眼BCDVA改善至20/50,眼底检查结果与前一次随访相同。结论:这是第一例年轻PAMM患者的报告,在没有全身血管危险因素和凝血功能正常的情况下,表现为局灶性血管闭塞,演变为CRAO形式的全局闭塞。本病例提示动脉闭塞可能在COVISHIELD™疫苗接种后产生暂时的继发性效果。随机对照试验和病例对照研究疫苗接种在促进健康个体血栓栓塞事件中的作用将提供对因果关系的深入了解。
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