Author: Fatma Sumer
Co-authors: Sevgi Subasi, Suleyman Karaman
Abstract
Abstract:Purpose: We present a patient with a dry-type age-related macular degeneration(AMD) who activated to neovascular type AMD 28 days after the injection of the COVID-19 vaccine from Pfizer-BioNTech (BNT162b2).
Case report: A 69-year-old female patient, who was followed up by our clinic for dry-type age-related macular degeneration (AMD), applied to us with the complaint of seeing a large ring in the center of her left eye for 5 days. In the detailed ophthalmological examination of the patient, it was seen that the best-corrected visual acuity (BCVA) in the left eye was 20/100, and the right eye was 20/20. Biomicroscopic anterior segment evaluation was normal. Fundus examination revealed drusen, a large pigment epithelial detachment (PED), and hemorrhage. Optical coherence tomography (OCT) and color fundus photographs were taken. OCT visualizes the components of the neovascular membrane, an RPE detachment (PED), neurosensorial detachment, intraretinal fluid, and subretinal hemorrhage. Drusen were observed in the right eye.
Conclusions: The conversion from dry-type AMD to neovascular-type AMD is likely to be related to the COVID-19 vaccine from Pfizer-BioNTech (BNT162b2) -induced mechanisms. Considering the case examples published in the literature and our case, it seems possible to conclude that the vaccine triggers the immune mechanism by causing stress. We believe that these case examples will both illuminate the areas that have not been clarified in the pathogenesis of the disease and raise awareness about the need to follow up with the patients more closely about vaccination.
We present a case of acute unilateral dry-type AMD converted to neovascular type shortly after immunization with the Pfizer-BioNTech mRNA COVID-19 vaccine. To the best of our knowledge, this is the first report of a stable dry-type AMD complication associated with the COVID-19 vaccine.
As is known, AMD is a blinding eye disease that becomes more common as people get older. The pathophysiology of AMD, including choroidal neovascularization and geographic atrophy, is influenced by inflammation.[6] There are two forms of AMD: dry (also known as non-neovascular, non-exudative, or atrophic) AMD and wet (also known as neovascular, non-exudative, or atrophic) AMD. Wet AMD (sometimes referred to as neovascular or exudative AMD) (AMD) [7]. Dry AMD is the most frequent kind, and it is marked by an increase in extracellular deposits known as drusen, as well as advanced-stage geographic atrophy (GA), which is marked by a decrease in RPE cells, photoreceptors, and choroidal capillaries.[7, 8] Patients with wet AMD, on the other hand, have choroidal neovascularization (CNV), which causes severe and rapid vision loss and is accompanied by hard exudate, leaky fluid, or retinal hemorrhage, RPE detachments, or the development of fibrosis surrounding neovascular tufts. Drusogenesis, RPE/photoreceptor degeneration, BM disruption, and the establishment of CNV are all caused by local inflammation. As a result, inflammation is thought to play a key role in the pathogenesis of both dry and wet AMD.[9]