Unilateral macular branch retinal vein occlusion in a healthy Indian woman following coronavirus disease vaccination: a case report and comprehensive literature review

Abstract Background: The coronavirus disease (COVID-۱۹) vaccines exert ocular adverse effects, including episcleritis, scleritis, anterior and recurrent uveitis, acute macular neuroretinopathy, paracentral acute middle maculopathy, ophthalmic vein thrombosis, Graves’ disease, arteritic anterior ischemic optic neuropathy, non-arteritic anterior ischemic optic neuropathy, central serous chorioretinopathy, Vogt-Koyanagi-Harada disease, multifocal choroiditis, cranial nerve palsies such as facial or abducens nerve palsy, acute zonal occult outer retinopathy, acute zoster ophthalmicus following re-activation of the varicella-zoster virus, acute retinal necrosis, and multiple evanescent white dot syndrome. In this case report, we explored the possibility of macular branch retinal vein occlusion and its association with COVID-۱۹ vaccination. Case Presentation: A ۴۴-year-old healthy woman presented with unilateral nonprogressive blurring of vision in the right eye (OD). Her best-corrected distance visual acuity (BCDVA) in OD was ۲۰ / ۴۰. The anterior-segment evaluation was normal. Fundus evaluation of the OD revealed macular branch vein occlusion. She had a history of COVID-۱۹ vaccination within ۱ month. The interleukin-۶ level was elevated six folds to ۳۰.۵ pg / mL. However, COVID-۱۹ immunoglobulin G (IgG) antibodies were negative. Infective etiologies, such as tuberculosis and dengue, were ruled out. Spectral-domain optical coherence tomography (SD-OCT) of the OD showed hyperreflective dots in the posterior vitreous, inner retinal swelling, and cystoid changes in the macula. The maximum central macular thickness was ۴۸۶ mm. A single dose of bevacizumab was administered at OD intravitreally. At the final follow-up ۲.۵ months later, her BCDVA had improved to ۲۰ / ۲۰ OD. Fundus evaluation revealed fewer retinal hemorrhages and cotton wool spots. SD-OCT of the OD showed a normal foveal contour and absence of cystoid spaces. Her maximum central macular thickness was ۲۳۶ mm. Conclusions: A temporal effect of vein occlusion secondary to COVISHIELD™ vaccination may occur in the absence of systemic risk factors. The interleukin-۶ level was elevated, and the remaining blood test results were within normal limits. Since this is a case report, it is limited by the absence of strong evidence to prove this causal relationship between macular branch retinal vein occlusion and the specific brand of COVID-۱۹ vaccination. Keywords: COVID-۱۹ virus vaccines ChAdOx۱ nCoV ۱۹ Covishield macula luteas retinal branch vein occlusion cystoid macular edema avastin intravitreal injection