No Red Flags for Risk of Retinal Vascular Occlusion After mRNA COVID-19 Vaccination

COVID-19 vaccines have mitigated the morbidity and mortality of COVID-19 infection in the US and elsewhere. Billions of doses have been given. Shortly after the initiation of administration of these vaccines, case reports and small series began appearing in the literature, implicating COVID-19 vaccination as a possible factor in the development of retinal complications.1 Retinal arterial and venous occlusion, paracentral acute middle maculopathy, and acute macular neuroretinopathy, among others, have been described. Retinal vascular occlusion, although rare, can occur in many clinical settings and, in view of the large number of COVID-19 vaccinations to date, publications implicating causation should be evaluated carefully, it is very difficult to determine whether the association of retinal vascular occlusion and prior vaccination is coincidental. Biologic plausibility derives from the fact that vaccine-induced immune thrombotic thrombocytopenia2 is a rare complication of adenoviral vector-based COVID-19 vaccination, leading to systemic ischemic and thrombotic events in other organ systems. Vaccine-induced immune thrombotic thrombocytopenia after messenger RNA (mRNA) vaccination is even rarer.2 Other vascular diseases have been attributed to COVID-19 vaccines, it should be noted that different vaccines could have different adverse effects.