EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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68 | EYEWORLD | DECEMBER 2022 C ORNEA Whorl-like late staining passed beyond the pu- pil, and vision was decreased permanently. But Dr. Chan noted that her other eye was good, so the patient didn't want anything done. The final case Dr. Chan shared was that of a 54-year-old male who was stable with medi- cally managed Crohn's disease. He had recent shingles immune stromal keratitis 3 months prior and was on valacyclovir and loteprednol. He was still somewhat immunocompromised but was stable. The patient complained of pain, redness, tearing, and blurry vision OD 2 weeks after getting the vaccine. He had a flare-up of shingles immune corneal keratitis. Dr. Chan stepped up his steroid, and a week later, the cor- neal edema had unusual dendritic-like epithe- lial lesions. Given the history of cold sores, she thought it was a herpes simplex complication or zoster. Dr. Chan had to balance the topical steroid with oral antiviral coverage. Eventually, she was more aggressive with treatment for this patient and added topical ganciclovir, as well as amniotic dehydrated membrane and acyclovir ointment. Two months later, she was able to get the patient back to a baseline of 20/50 vision. Dr. Chan said for the first time in history, there is an mRNA vaccine that delivers specific genetic information to host cells to produce foreign proteins, which leads to the immune system being upregulated. Inflammatory events have been reported with all of the different COVID-19 vaccines. There are still unknowns about the mechanism of action of these vac- cines, she said, so it's important for physicians to pay attention when asking patients about any inflammatory reactions and acknowledge when the last COVID-19 vaccine was. "I have counseled patients about the signs and symptoms of ocular inflammation," she said. She recommends transplant patients get the COVID-19 vaccine series prior to their trans- plant and recommends a baseline prophylaxis dose in high-risk grafts. continued from page 67 • Open access to all EyeWorld articles • Online Exclusives • Weekly updates • Content you can trust with a medical Editorial Board comprised of diverse, subject-matter experts WWW. EYEWORLD.ORG In-depth info on diagnostics, treatments, technologies, techniques, and opinions in anterior segment surgery on www.EyeWorld.org