"1. Introduction
... Corneal allograft transplantation is the most frequently performed organ transplant procedure worldwide. The cornea is one of the few organs with an immune privilege and, thus, a decreased rate of allograft rejection. However, in April 2021, two cases of acute corneal rejection after Descemet membrane endothelial keratoplasty (DMEK) with a possible association with COVID-19 vaccination were reported. In addition, several reports have previously described corneal allograft rejection being triggered by vaccinations, including those secondary to Influenza and Hepatitis B vaccine administration. These reports have raised concerns among ophthalmologists as future booster doses of COVID-19 vaccines are being discussed, which may impact outcomes in future corneal allograft recipients...
We performed a systematic review of the corneal allograft rejection cases reported after COVID-19 vaccination to identify the novel recipient characteristics and clinical findings of allograft rejection. To our knowledge, this is the first systematic review of corneal allograft rejections after COVID-19 vaccine administration...
3. Results
... 13 articles met the inclusion criteria and were included in the systematic review...
3.1. Study Characteristics and Demographic Features
The articles included in this systematic review were published between 29 April 2021, and 23 December 2021... A total of 21 patients (23 eyes) who experienced corneal graft rejection after COVID-19 vaccine administration were identified in the 13 studies...
4. Discussion
... [D]espite the low occurrence rates of high-risk complications after vaccination, an appreciable number of vaccine recipients have experienced a wide range of post-vaccination symptoms. At present, COVID-19 vaccines are believed to be associated with a spectrum of systemic symptoms, and appropriate interventions should be undertaken on a case-by-case basis. In this systematic review, we extracted data regarding clinical features of acute corneal allograft rejection (21 patients [23 eyes]) that occurred after the administration of the COVID-19 vaccine. Among them, >95% of eyes (22/23 eyes) had corneal allograft rejection within 3 weeks from vaccination (mean: 10.4 days, median: 7 days). As the global society promotes additional booster schedules in consideration of emerging variants, it is empirical that the effects of these vaccines on corneal grafts be elucidated."
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