Acute panuveitis after COVID-19 mRNA booster vaccination following cataract surgery

Timothy-Paul H Kung; Charles Zhang; Sandra F Sieminski

doi:10.1016/j.ajoc.2022.101726

Acute panuveitis after COVID-19 mRNA booster vaccination following cataract surgery

Am J Ophthalmol Case Rep. 2022 Oct 13:28:101726. doi: 10.1016/j.ajoc.2022.101726. eCollection 2022 Dec.

Authors

Timothy-Paul H Kung¹, Charles Zhang², Sandra F Sieminski²

Affiliations

¹ Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 955 Main St, Buffalo, NY, 14203, USA.
² Department of Ophthalmology, Ross Eye Institute, University at Buffalo, 1176 Main St, Buffalo, NY, 14209, USA.

Abstract

Purpose: To report a case of presumed COVID-19 Pfizer third dose (booster) vaccination leading to severe panuveitis mimicking acute endophthalmitis in the early postoperative period following routine cataract extraction and intraocular lens implantation.

Observations: A 68-year-old female with mild refractive error who previously received 2 doses of the BNT162b2 vaccine underwent routine cataract extraction and intraocular lens implantation in the right eye. On postoperative day (POD) 2 the patient received her BNT162b2 booster vaccination. On POD 3 the patient's vision was hand motion at face with photophobia. Anterior segment examination was significant for 2+ conjunctival injection, mild stromal edema, 4+ cell and flare with trace hypopyon, and 4+ anterior vitreous cell without any wound leak. Subsequent Gram staining, culture for aerobic and anaerobic bacteria, KOH preparation, and PCR testing for infectious organisms were also obtained, all of which were found to be negative. ESR and CRP values were also negative. The patient was started on intravitreal injections of vancomycin and ceftazidime, as well as oral moxifloxacin, fortified vancomycin and tobramycin drops, prednisolone acetate 1%, and atropine 1%. On POD 5 the patient reported significant improvement of her vision and was found to have 20/80 vision. On POD 12 her vision improved to 20/25, and improved further on POD 19 to 20/20 vision with a completely normal examination. Cultures remained negative throughout the entire course.

Conclusions and importance: This is the first report to suggest a possible association between the BNT162b2 booster vaccination and development of acute panuveitis in the postoperative period after routine cataract extraction and intraocular lens implantation. This condition may mimic acute bacterial postoperative endophthalmitis and may portend a more favorable prognosis, but the authors believe such cases should nonetheless be treated aggressively as presumed infection.

Keywords: BNT162b2; COVID-19; Cataract extraction and intraocular lens implantation; Panuveitis; Postoperative endophthalmitis; mRNA vaccine.

Publication types

Case Reports