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Acute onset of Vogt-Koyanagi-Harada disease after administration of inactivated COVID-19 vaccine. Wide-field color fundus photography of a previous healthy woman who developed bilateral multiple serous retinal detachment 10 days following the first dose of the Sinopharm inactivated COVID-19 vaccine (A), corresponding to the OCT revealing intraretinal and subretinal fluid (B). The patient started on oral steroid with tapering dose, and the bullous retinal detachment resolved completely after 6 weeks of follow-up (C,D).
Source publication
Aims: To report potential vaccine-induced ocular adverse events following inactivated COVID-19 vaccination (Sinopharm and Sinovac). Methods: This case series took place at a tertiary referral center in the southeast of China (Xiamen Eye Center in Fujian Province) from February 2021 to July 2021. Patients who received the first dose of inactivated C...
Contexts in source publication
Context 1
... anterior segment examination revealed a conjunctiva congestion, gray fine keratic precipitate, and anterior chamber cell in both eyes. The dilated fundus examination showed multiple serous retinal detachment (Figure 2), which was consistent with intraretinal and subretinal fluid, shown on OCT Figure 2B. Tests for HIV, syphilis and tuberculosis were negative. ...
Context 2
... anterior segment examination revealed a conjunctiva congestion, gray fine keratic precipitate, and anterior chamber cell in both eyes. The dilated fundus examination showed multiple serous retinal detachment (Figure 2), which was consistent with intraretinal and subretinal fluid, shown on OCT Figure 2B. Tests for HIV, syphilis and tuberculosis were negative. ...
Citations
... Auditory manifestations (tinnitus, hearing loss and vertigo) and others (including headache, neck and back stiffness) usually occur before or concurrently with ocular involvement 52 . A previous study linked VKH to COVID-19 53 . The VKH-like patients in this series responded favorably to corticosteroid therapy. ...
Purpose
To define the characteristics of fundus manifestations in COVID-19-infected individuals with multimodal imaging techniques.
Methods
A cross-sectional multicenter and multimodal imaging study including 90 patients was conducted. All patients with a visual complaint occurring immediately after COVID-19 infection were referred to six clinics between December 2022 and February 2023. Demographic information and the temporal relationship between COVID-19 infection and visual symptoms were documented. The characteristics of the fundus lesions were evaluated using multimodal imaging.
Results
Ninety patients from 6 hospitals were enrolled in this study, including 24 males (26.67%) and 66 (73.33%) females. Seventy-eight patients (86.66%) (146 eyes) were diagnosed with AMN. The AMN patients were primarily young women (67.95%). Sixty-eight patients (87.18%) had AMN in both eyes. Thirty-eight eyes (24.36%) included Purtscher or Purtscher-like lesions. AMN lesions were evident in all OCT and IR images (100.00%). mf-ERG and VF abnormalities corresponded closely to the shape and location of the lesion images. Eleven cases were diagnosed with simple Purtscher or Purtscher-like retinopathy (2 cases, 2.22%), VKH or VKH-like uveitis (3 cases, 3.33%), MEWDS (2 cases, 2.22%), and ROCM (5 cases, 5.56%).
Conclusions
After COVID-19 infection, diversified fundus lesions were evident in patients with visual complaints. In this report, AMN was the dominant manifestation, followed by Purtscher or Purtscher-like retinopathy, MEWDS, VKH-like uveitis, and RCOM.
... The COVID-19 vaccines had associated ocular AEs 16,49,307,308 . There have been reports of the GVG Sp triggering a pro-inflammatory response in human corneal EpCs, with increased oxidative stress and DNA double-strand breaks in human peripheral blood mononuclear cells 10 . ...
In this literature review, we assess the pathophysiology of severe adverse events observed after vaccination with DNA and mRNA vaccines against COVID-19, despite reports of their overall effectiveness. The focus is on the perspective of an undersulfated and degraded glycocalyx, considering its impact on immunomodulation, inflammatory responses, coagulation, and oxidative stress. The paper explores various factors that lead to glutathione and inorganic sulfate depletion and their subsequent effect on glycocalyx sulfation and other metabolites, including hormones. Components of COVID-19 vaccines, such as DNA and mRNA material, spike protein antigen, and lipid nanoparticles, are involved in possible cytotoxic effects. The common thread connecting these adverse events is endotheliopathy or glycocalyx degradation caused by depleted glutathione and inorganic sulfate levels, shear stress from circulating nanoparticles, aggregation, and formation of protein coronas, leading to imbalanced immune responses and chronic release of pro-inflammatory cytokines, ultimately resulting in oxidative stress and systemic inflammatory response syndrome. By understanding the underlying pathophysiology of severe adverse events, better treatment options can be explored.
... The clinical samples involved in such studies include cerebrospinal fluid aqueous humour and serum, and the types of viruses tested include herpes simplex virus (HSV), herpes zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV) and human herpes virus type 6 (HHV-6) [32,[50][51][52]. The research trends related to viral infection have declined in the past five years, but it is worth noting that many clinical studies and case reports in the past three years found that VKHD was associated with COVID-19 as well as with the COVID-19 vaccine [54][55][56][57][58][59][60][61]. However, research on the basis for this hypothesis is still lacking. ...
Purpose
As an autoimmune disease, Vogt‒Koyanagi‒Harada disease (VKHD) is a main type of uveitis in many countries and regions, significantly impacting patient vision. At present, information regarding VKHD is still limited, and further research is needed. We conducted a bibliometric analysis to characterize the overall status, current trends, and current focus of VKHD research.
Method
Literature published from 1975 to 2022 was obtained from the Web of Science core collection and analysed with the R-language packages Bibliometrix, VOSviewer, and CiteSpace software.
Results
A total of 1050 papers on VKHD were retrieved from 261 journals, and 16,084 references were obtained from the papers in the original search. The average annual number of published articles was approximately 21.9, and the number of publications rapidly increased after 2004. The journal Ocular Immunology and Inflammation published the most papers on VKHD, while the American Journal of Ophthalmology has the highest citation frequency. The leading countries were Japan, China (PRC), and the United States of America (USA). Yang PZ from Chongqing Medical University was the most prolific and cited author. The most frequently cited study discussed revision of VKHD diagnostic criteria. An analysis of the highest frequency keywords showed that most research focused on the treatment, diagnosis, and pathogenesis of VKHD and its relationship with other related diseases. At present, the most urgent research direction is in the relationship between COVID-19 or COVID-19 vaccines and VKHD and the corresponding mechanisms underlying it.
Conclusion
Utilizing dynamic and visualization tools, bibliometrics provides a clear depiction of the research history, development trends, and research hotspots in VKHD It serves as a valuable tool for identifying research gaps and areas that necessitate further exploration. Our study revealed potential directions for future VKHD research, including investigating specific molecular mechanisms underlying the disease, exploring the clinical utility of optical coherence tomography angiography and other diagnostic techniques, and conducting clinical research on novel therapeutic drugs.
... [21] VKH was the most common cause in the series and was reported in 17 patients following anti-SARS-CoV-2 vaccinations. [21] As details of these patients were not available, we did not include them in Table 2. Chen et al. [22] reported seven patients who suffered ocular adverse reactions following anti-SARS-CoV-2 vaccinations. Among them, three patients developed bilateral VKH-like uveitis, and one had an exacerbation of VKH with a second dose of vaccine. ...
... There are reports of three patients who had been recovering or recovered from VKH after receiving the first dosage of the vaccine deteriorated after receiving the second dose of the vaccine. [22][23][24] All three patients responded well to corticosteroid therapy when they developed VKH following first vaccination, and a rebound inflammation was observed after the second dose of the vaccine. [22][23][24] Among these 46 patients who developed VKH or VKH-like disease following anti-SARS-CoV-2 vaccinations, 25 (54%) received the Pfizer-BioNTech BNT162b2 vaccine. ...
... [22][23][24] All three patients responded well to corticosteroid therapy when they developed VKH following first vaccination, and a rebound inflammation was observed after the second dose of the vaccine. [22][23][24] Among these 46 patients who developed VKH or VKH-like disease following anti-SARS-CoV-2 vaccinations, 25 (54%) received the Pfizer-BioNTech BNT162b2 vaccine. [21,[24][25][26][27][28][29][30][31][32][33] The next common vaccine was the Moderna mRNA-1273 vaccine administered to six patients (13%). ...
Vogt-Koyanagi-Harada (VKH) disease, a bilateral granulomatous panuveitis associated with multisystem involvement, is a T-cell-mediated autoimmune disorder in which cytotoxic T-cell target melanocytes in genetically susceptible individuals. Recently, there has been an increase in literature on the new onset of uveitis and reactivation of previously diagnosed cases of uveitis following Covid-19 vaccinations. It has been postulated that Covid-19 vaccines can lead to an immunomodulatory change resulting in an autoimmune phenomenon in the recipients. VKH following COVID-19 infection was reported in four patients and a total of 46 patients developing VKH or VKH-like disease following COVID-19 vaccinations. There are reports of four patients who had been recovering or recovered from VKH after receiving the first dosage of the vaccine and developed worsening of ocular inflammation after receiving the second dose of the vaccine.
... The clinical samples involved in the study included cerebrospinal uid aqueous humor and serum, and the types of viruses tested included herpes simplex virus (HSV), herpes zoster virus (VZV), Cytomegalovirus (CMV), and Epstein-Barr virus (EBV) and human herpes virus type 6 (HHV-6) [23,[41][42][43]. The trend of research related to viral infection has declined in the past ve years, but it is worth noting that many clinical studies and case reports have found VKHD associated with COVID-19 in the past three years as well as with the COVID-19 vaccine [45][46][47][48][49][50][51][52]. However, research on the etiology for this hypothesis is still lacking. ...
Background:
As an autoimmune disease, Vogt‒Koyanagi‒Harada disease (VKHD) is one of the main types of uveitis in many countries and regions significantly impacting patent’s vision. At present, information regarding VKHD is still limited, and further research is needed. We conducted a bibliometric analysis to characterize the overall status, current trends, and current focus of VKHD research.
Methods:
Literature published from 1975 to 2022 was obtained from the Web of Science core collection and analyzed by the R-language packages Bibliometrix, VOSviewer, and CiteSpace software.
Results:
A total of 1050 papers on VKHD were retrieved from 261 journals and 16,084 references were obtained from the papers in the original search. The average annual number of published articles is approximately 21.9, and the number of publications rapidly increased after 2004. Ocular Immunology and Inflammation is the journal that published the most papers on VKHD, while the American Journal of Ophthalmology has the highest cited frequency. The leading countries were Japan, China (PRC), and the United States of America (USA). Yang PZ. from Chongqing Medical University is the most prolific and cited author. The most frequently cited literature is the literature on the revision of VKHD diagnostic criteria. An analysis of high-frequency keywords showed that the research focused on the treatment, diagnosis, and pathogenesis of VKHD and its relationship with other related diseases. At present, the urgent research direction is the relationship and specific mechanism between COVID-19 or COVID-19 vaccines and VKHD.
Conclusion:
Bibliometrics can clearly show the research history, development trends, and research hotspots of VKHD through dynamic and visualization tools. It is an efficient way to study the literature and is helpful for future researchers.
... Chen et al. 25 Systemic steroids followed by tapering (6 weeks later) BCVA OU 0; Recovered Chen et al. 26 Peribulbar triamcinolone acetonide followed by tapering (5 days later) Recovered Pillar et al. 27 Oral prednisone followed by tapering (8 weeks later) BCVA OU 0; recovered Han et al. 28 Oral prednisone followed by tapering; Cyclosporin; Micropulse laser treatment (8 months later) Recovered, (5 months later) inflammation relapsed Kim et al. 29 Pulse methylprednisolone followed by tapering oral prednisone (6 weeks later) BCVA OU 0; recovered Goyal et al. 30 Khochtali et al. 31 Oral prednisolone followed by tapering (11 days later) BCVA OU 0; recovered Sato et al. 32 Prednisolone followed by tapering; Cyclosporine A (7 months later) BCVA OU 0; recovered Yamaguchi et al. 33 IV methylprednisolone followed by tapering oral prednisolone (3 months later) BCVA OU 0; recovered Daldoul et al. 34 Oral prednisolone followed by tapering; Mycophenolate mofetil (1 month later) Recovered Wang et al. 35 Oral prednisolone followed by tapering; Cyclosporine A; Azathioprine (4 months later) BCVA OD 0.097, OS 0; recovered a BCVA had been converted to LogMAR. Abbreviations: BCVA, best corrected visual acuity; IV, intravenous; OD, oculus dextrus; OS, oculus sinister; OU, oculus unati. ...
Vogt-Koyanagi-Harada (VKH) disease is a rare and serious ocular adverse reaction following COVID-19 vaccination. This study aimed to evaluate the clinical features, diagnosis and management of COVID-19 vaccine-associated VKH disease. Case reports of VKH disease after COVID-19 vaccination were collected up to February 11, 2023 for retrospective analysis. Twenty-one patients (9 males and 12 females) were included, with a median age of 45 years (range 19–78), from three main regions, Asia (12/21), the Mediterranean region (4/21), and South America (5/21). Fourteen patients developed symptoms after the first dose of the vaccine, and 8 after the second dose. Vaccines included mRNA vaccine (10 cases), virus vector vaccine (6 cases), and inactivated vaccine (5 cases). The average time interval from vaccination to onset of symptoms was 7.5 days (range 12 hours to 4 weeks). All 21 patients experienced visual impairment after vaccination, with 20 cases involving both eyes. Sixteen patients showed symptoms of meningitis. Serous retinal detachment was observed in 16 patients, choroidal thickening was observed in 14, aqueous cell in 9, and subretinal fluid in 6. CSF pleocytosis was detected in 7 patients and skin symptoms were found in 3 patients. All patients received corticosteroid therapy, and 8 also received immunosuppressive agents. All patients recovered well, with a mean recovery time of 2 months. Early diagnosis and early treatment are crucial to the prognosis of patients with VKH after vaccination with COVID-19 vaccine. The risk of vaccination against COVID-19 in patients with a history of VKH disease should be evaluated clinically.
... Their patients had various types of diseases, such as anterior uveitis (n = 5, 11.9%), retinal vein occlusion (n = 5, 11.9%), herpetic keratitis (n = 3, 7.1%), multiple evanescent white dot syndrome (MEWDS) (n = 3, 7.1%), toxoplasma retinochoroiditis (n = 3, 7.1%), VKH reactivation (n = 2, 4.8%), and anterior scleritis (n = 2, 4.8%). Chen and colleagues reported a case series in Asia in which 10 eyes of 7 patients exhibited ocular complications after vaccination [16]. Unlike in the above-mentioned reports by Testi and colleagues and Bolletta and colleagues, most of the cases in the study by Chen and colleagues were diagnosed with VKH (n = 3, 30.0%), as in our study. ...
PurposeTo report the characteristics of a case series of ocular inflammatory events following COVID-19 vaccination in Japan.Study designRetrospective multicenter studyMethods
In this retrospective multicenter survey, a questionnaire was sent to 16 Japanese hospitals that had uveitis specialty clinics. Information on patients who developed ocular inflammatory events within 14 days of COVID-19 vaccination between February 2021 and December 2021 was collected.ResultsThirty-seven patients were diagnosed with ocular inflammatory events following COVID-19 vaccination. The mean age was 53.4 ± 16.4 years (range, 26-86 years), and the mean time to onset after vaccination was 6.3 ± 4.2 days (range, 1-14 days). Vogt-Koyanagi-Harada disease (VKH) was the most common event (n = 17 patients, 46%), followed by anterior uveitis (n = 6), infectious uveitis (n = 3), acute zonal occult outer retinopathy (AZOOR) (n = 2), sarcoidosis-associated uveitis (n = 1), acute posterior multifocal placoid pigment epitheliopathy (APMPPE) (n = 1), optic neuritis (n = 1), multiple evanescent white dot syndrome (MEWDS) (n = 1), Posner-Schlossman syndrome (n = 1), and unclassified uveitis (n = 4). Twenty-eight cases occurred after BNT162b2 vaccination (Pfizer-BioNTech) and 8 after mRNA-1273 vaccination (Moderna), whilst 1 patient had no information about vaccine type.ConclusionsCOVID-19 vaccination can be related to various types of ocular inflammatory events. When we encounter patients with ocular inflammatory disease, we should consider that it may be an adverse effect of COVID-19 vaccination.
... [4][5][6][7][8][9][10][11] There are also several previous reports about inactivated COVID-19 vaccine associated uveitis and other ocular complications. 5,[8][9][10]12,13 Most of them are case reports. Here, we report a case series of ocular inflammatory events associated with the administration of inactivated COVID-19 vaccination without previous ocular inflammatory history. ...
... There were several case reports on inactivated COVID-19 vaccines BBIBP-CorV or Corona Vac-associated uveitis and other ocular complications. 5,[8][9][10]12,13 However, it is not known whether the three types of COVID-19 vaccines have significant difference in safety, particularly in relation to ocular health. ...
To report potential vaccine-induced inflammatory ocular adverse events following inactivated COVID-19 vaccination. Retrospective study of patients with uveitis and other ocular complications following inactivated coronavirus disease 2019 (COVID-19) vaccination at a tertiary referral center between May 2021 and August 2021. Data collection consisted of demographic and clinical data. The study included 8 eyes of 5 patients (4 females, 1 male), with a mean age of 37.2 ± 12.5 years (range 28–59 years). Mean time between vaccination and ocular complications onset was 13.2 ± 11.9 days (range 3–30 days), including two patients after the first dose of the vaccine and 3 patients after the second dose. The cases reported were three anterior uveitis, one herpetic keratitis and iridocyclitis, and one posterior uveitis. Patients received treatment with local and/or systemic steroids and all the patients had good visual outcomes. Ocular inflammatory events may occur after vaccination with possible gender preponderance. However, they are rare and manageable. Overall, the efficacy and safety of vaccination should be emphasized.
... Various ocular adverse events, including non-arteritic anterior ischemic optic neuropathy, central serous chorioretinopathy (CSC), and Vogt-Koyanagi-Harada (VKH) disease, have been reported [2][3][4][5]. VKH disease is a chronic, bilateral, granulomatous ocular and multisystem inflammatory disorder [6] that responds well to adequate, long-range steroid therapy with or without immunosuppressive agents [3,4,[7][8][9][10]. Here, we report on a patient who developed an incomplete VKH disease in close temporal association with an inactivated COVID-19 vaccine. ...
With the promotion of mass COVID-19 vaccination in the elimination of the SARS-CoV-2 pandemic, new side effects, including ocular complications, are emerging. In this study, we report on a 62-year-old Chinese man who developed Vogt–Koyanagi–Harada (VKH) disease six days after his third dose of an inactivated COVID-19 vaccine, with a preceding severe headache and tinnitus. His medical history included tuberculosis 20 years prior and hypertension. Systemic prednisone was administered, resulting in completely relieved inflammation and improved visual acuity. Another three and a half months later, the visual acuity of his right eye slightly decreased due to complicated central serous chorioretinopathy (CSC) disease. By gradually replacing prednisone with cyclosporine within 2 months, the subretinal fluid was completely absorbed at the last visit. Steroid-related CSC during the treatment course of VKH disease after COVID-19 vaccination has never been reported before. By reviewing relative literature, we discuss the mechanism of CSC onset in our case and the potential therapeutic strategies. Complicated CSC may develop in the eyes with vaccine-related VKH after steroid treatment. Ophthalmologists should be aware of this condition, carefully distinguish complicated CSC with inflammation relapse, and adjust the medication in a timely manner.
... Other than uveitis, diverse ocular complications have been observed post-COVID-19 vaccination. Some of these complications, as reported by Bolletta et al. [35] from the ocular immunology unit, Reggio Emilia, Italy, are summarized in Table 2. Table 3 shows ocular adverse events observed in association with inactivated COVID vaccines reported by Chen et al. [36] from a tertiary care center in southeast China. ...
Coronavirus disease is a highly infectious viral disease caused by severe acute respiratory syndrome virus (SARS nCoV2). It was declared a pandemic within a few months of identification of its index case. The spread of COVID-19 across the globe was rampant, overwhelming healthcare systems and crippling global economies. Since the world was caught off guard by the pandemic, vaccine programs had to be rolled out in emergency to curb its spread. Ten vaccines have been granted Emergency Use Authorization thus far. Much of the side effects we know today are post-marketing adverse effects. Most of them are mild like myalgia and injection-site reactions, but a few of them such as post-vaccination autoimmune diseases have alerted the medical community. These include vaccine-induced thrombotic thrombocytopenia, autoimmune hepatitis, myocarditis, and Graves’ disease. We attempt to summarize the diverse autoimmune phenomena reported after COVID-19 vaccination, with an aim to sensitize the medical community so that they can be better equipped in management when confronted with these diseases. This review by no means refutes the potential benefit of COVID-19 vaccination which has consolidated its place in preventing infections and substantially reducing severity and mortality.
