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Association of Ocular Adverse Events With Inactivated COVID-19 Vaccination in Patients in Abu Dhabi

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Can ocular adverse events present after inactivated COVID-19 vaccine?

Findings  In a retrospective case series, 9 patients presented with ocular complaints 5.2 days after administration of an inactivated COVID-19 vaccine. One patient was diagnosed with episcleritis, 2 with anterior scleritis, 2 with acute macular neuroretinopathy, 1 with paracentral acute middle maculopathy, and 1 with subretinal fluid.

Meaning  Mild, reversible ocular adverse events, both in the anterior and posterior segment, were noted after patients received the inactivated COVID-19 vaccine, although a causal relationship cannot be established from this case series.

Abstract

Importance  As vaccinations against COVID-19 continue, potential ocular adverse events should be reported in detail to increase awareness among the medical community, although typically, a causal relationship cannot be established definitively.

Objective  To describe ocular adverse events that occur soon after receiving an inactivated COVID-19 vaccination (Sinopharm).

Design, Setting, and Participants  This case series took place from September 2020 to January 2021 at Cleveland Clinic Abu Dhabi, a tertiary referral center. Patients who reported ocular adverse events and presented within 15 days from the first of 2 doses of an inactivated COVID-19 vaccine were analyzed.

Main Outcomes and Measures  Each patient underwent Snellen best-corrected visual acuity that was then converted to logMAR, applanation tonometry, and biomicroscopic examination with indirect ophthalmoscopy. Color fundus photography was obtained with a conventional 9-field fundus photography camera or with a widefield fundus photography system. Optical coherence tomography and optical coherence tomographic angiography images were obtained. Sex, race, age, and clinical data were self-reported.

Results  Nine eyes of 7 patients (3 male individuals) presenting with ocular complaints following COVID-19 vaccine were included in the study. The mean (SD) age was 41.4 (9.3) years (range, 30-55 years); the mean best-corrected visual acuity was 0.23 logMAR (range, 0-1 logMAR; approximate Snellen equivalent, 20/32). The mean time of ocular adverse event manifestations was 5.2 days (range, 1-10 days). One patient was diagnosed with episcleritis, 2 with anterior scleritis, 2 with acute macular neuroretinopathy, 1 with paracentral acute middle maculopathy, and 1 with subretinal fluid.

Conclusions and Relevance  In this case series study of 7 patients, the timing of transient and ocular complications 5.2 days after vaccination with an inactivated COVID-19 vaccine supported an association with the ocular findings, but a causal relationship cannot be established from this study design.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Francesco Pichi, MD, Eye Institute, Cleveland Clinic Abu Dhabi, PO Box 112412, Al Maryah Island, Abu Dhabi, United Arab Emirates (ilmiticopicchio@gmail.com).

Accepted for Publication: May 24, 2021.

Published Online: September 2, 2021. doi:10.1001/jamaophthalmol.2021.3477

Author Contributions: Drs Pichi and Ghazi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Pichi, Neri, Ghazi.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Pichi, Aljneibi, Neri, Hay.

Critical revision of the manuscript for important intellectual content: Neri, Dackiw, Ghazi.

Statistical analysis: Pichi, Neri.

Administrative, technical, or material support: Aljneibi, Hay, Dackiw.

Supervision: Pichi, Neri, Ghazi.

Conflict of Interest Disclosures: None reported.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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