"Abstract
... [W]ith large-scale [COVID-19] vaccination has come the gradual emergence of immunological phenomena caused by these new vaccines. Herein, we report a 48-year-old female with a sudden onset of inferior visual field defects in the left eye following her first dose of the ChAdOx1 vaccine. Dilated fundus examination combined with optical coherence tomography and fluorescein angiography confirmed the diagnosis of branch retinal artery occlusion. Within 4 weeks following vaccination, symptoms associated with hearing impairment developed, and magnetic resonance imaging revealed leptomeningeal enhancement. The diagnosis of Susac syndrome (SS) was confirmed...
1. Introduction
... Ocular adverse events, including abnormalities in anterior and posterior segments, also present in some cases after COVID-19 vaccination, and retinal disease is one of the most common adverse events...
Discussion
SS is... characterized by the triad of encephalopathy, branch retinal artery occlusions (BRAOs), and hearing loss. The ocular symptoms of SS often present as blurred vision or deficits of the visual field, and the most common finding is BRAO...
Up to 94.6% of people receiving the ChAdOx1 vaccine reported at least one side effect... [S]tudies have reported that some clinical features from the syndromes of vaccine-induced immune thrombocytopenia and thrombosis (VITT), which had high mortality, were associated with the ChAdOx1 vaccine...
The immunological response to the spike antigen or to components of the chimpanzee or human adenovirus can cause ocular diseases. Recently, several systemic reviews of the COVID-19 vaccine have demonstrated multiple ocular manifestations following vaccination with the ChAdOx1 vaccine, which included corneal graft rejection, acute macular neuroretinopathy (AMN), multifocal choroiditis, acute retinal necrosis, and optic neuritis with longitudinal extensive transverse myelitis. Superior ophthalmic vein thrombosis and cerebral venous sinus thrombosis were also reported following the ChAdOx1 vaccine, which may be also related to the mechanism of VITT. After ChAdOx1 vaccination, soluble spike variants that can be accidentally generated during transcription may induce thrombotic events via an antibody-mediated mechanism when binding to ACE2-expressing endothelial cells in blood vessels. The molecular mimicry effect causes retinal pathologies by creating antibodies against self-antigens and inducing autoimmunity via the adaptive immune system. Moreover, the proinflammatory or procoagulant response toward vessel endothelial cells may also enhance and induce retinal pathologies. In the ocular manifestations mentioned above, AMN, consisting of microvascular ischemia in the deep capillary plexus of the retina and central retinal vein occlusion, has been reported following COVID-19 vaccination."
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