Descemet's membrane endothelial keratoplasty rejection after SARS-COV2 infection or vaccination: 2-year retrospective study

J Bijon; S Elahi; M Dubois; W Ghazal; R Courtin; C Panthier; D Gatinel; A Saad

doi:10.1016/j.jfo.2024.104117

Descemet's membrane endothelial keratoplasty rejection after SARS-COV2 infection or vaccination: 2-year retrospective study

J Fr Ophtalmol. 2024 Mar 5;47(5):104117. doi: 10.1016/j.jfo.2024.104117. Online ahead of print.

Authors

J Bijon¹, S Elahi¹, M Dubois¹, W Ghazal¹, R Courtin¹, C Panthier¹, D Gatinel¹, A Saad²

Affiliations

¹ Department of Ophthalmology, Rothschild Foundation, Paris, France.
² Department of Ophthalmology, Rothschild Foundation, Paris, France. Electronic address: dralainsaad@gmail.com.

PMID: 38696860
DOI: 10.1016/j.jfo.2024.104117

Abstract

Purpose: To assess the incidence of Descemet's membrane endothelial keratoplasty (DMEK) rejection potentially associated with coronavirus disease 2019 (COVID-19) infection or vaccination, and its association with known rejection risk factors during the first two years of the pandemic.

Methods: This retrospective study included patients with DMEK rejection between January 2020 and December 2021. Diagnostic criteria were based on symptoms, visual acuity, and other clinical assessments. Risk factors for graft rejection were considered, and a telephone survey was conducted to identify possible preceding COVID-19 infection or vaccination.

Results: Of 58 patients, 44 were included. Six patients (14%) reported COVID-19 infection, with one immediate endothelial graft rejection (EGR) post-infection. After vaccine availability, 13 of 36 patients had EGR at an average of 2.7 months post-vaccination. Five (38%) had immediate EGR following vaccination, four of which had concomitant risk factors for rejection.

Conclusion: Although the risk of endothelial graft rejection (EGR) associated with COVID-19 infection or vaccination appears to be extremely low, there may be a causative relationship, especially in patients with pre-existing risk factors for EGR. A temporary increase in anti-rejection treatment following COVID-19 infection or vaccination is recommended, especially in patients with pre-existing risk factors, along with closer monitoring during the subsequent 4 to 8 weeks.

Keywords: COVID-19; Corneal graft rejection; Descemet's membrane endothelial keratoplasty; Kératoplastie endothéliale de la membrane de Descemet; Rejet de greffe cornéenne; SARS-COV2; Vaccination.