Eyeworld

66 | EYEWORLD | DECEMBER 2022 C HOT TOPICS IN OPHTHALMOLOGY ORNEA by Ellen Stodola Editorial Co-Director About the physicians Clara Chan, MD Associate Professor Department of Ophthalmology and Vision Sciences University of Toronto Toronto, Canada Bennie H. Jeng, MD Professor and Chair Department of Ophthalmology University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania thing antigenic in the eye, and the vaccination boosts the immune system, potentially causing the immune system to go after the transplant," Dr. Jeng said. However, he said, "it can be very hard to prove causation in these cases." Timing wise, if a patient has a graft that's been doing fine for 6 years, they get the COVID-19 vaccine, and a few weeks later there is a rejection for the first time, that's suspicious, Dr. Jeng said. While Dr. Jeng said he hasn't experienced any of these cases in his practice, there have been multiple reports in the literature. "My patients ask me, because I think they have heard about the possibility, 'Is it OK if I get the COVID-19 vaccination?' My answer is 'You should get it, and if it causes graft rejection, we can treat that and usually get you over it.'" There are some doctors who will start upping patients' steroids for a couple of weeks before the vaccination and continue for a couple of weeks after, then bring them back down to potentially protect against any reaction. There are others like Dr. Jeng who will just have pa- tients call immediately if there are any reactions after the vaccine. These reactions could include red eye, light sensitivity, pain, and decreased vision, among other symptoms. Dr. Jeng prefers the latter approach because adverse reactions are infrequent, so you may be overtreating 500 people to catch one. Additionally, most of the time if you treat after the fact, you can get pa- tients through the episode with successful graft survival, he said. While you can't always plan for when patients get their vaccine, Dr. Jeng said that if given the choice, he would recommend they get the vaccine before having a corneal trans- plant. If there is a chance that the vaccine could cause rejection, it's potentially a lot of resources wasted. Dr. Chan presented on the topic of vaccina- tion and the possibility of graft rejection during the Lindstrom Symposium at the 2022 ASCRS Annual Meeting. In her presentation, titled "Are We Seeing More Inflammatory Corneal Events?," she shared cases she has encountered of corneal complications after COVID-19 vacci- nation. Because of the pandemic, Dr. Chan said How vaccines may affect the cornea T he push for widespread COVID-19 vaccination has renewed the focus on the side effects that vaccines may have. It's an especially unique situa- tion due to the distinct timeframe for this mass vaccination campaign. Clara Chan, MD, and Bennie H. Jeng, MD, spoke about po- tential ocular impacts of the vaccine and what physicians should look for. The concept of vaccine-induced corneal graft rejection, or any ocular inflammation, is not new, Dr. Jeng said. "Long ago, people wondered if a flu vaccine or any other vaccina- tion can trigger an immune reaction," he said. "It makes sense because the vaccination boosts your immune system, and your immune system gets revved up." Previously, physicians were more likely to see random case reports, but it is appearing more now because of the world- wide push for a higher percentage of people to get COVID-19 vaccinations in a relatively short timeframe. "With a corneal graft, there is some- Left eye slit lamp photo of patient with moderate limbal stem cell deficiency (note the whorl pattern of "late" fluorescein staining) with best corrected Snellen vision of 20/50

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