No Increase in Corneal Graft Rejections Due to COVID-19 Vaccines

COVID-19 vaccines are not associated with corneal graft rejections, according to a study published in Cornea. This finding provides reassurance regarding the safety of the vaccine, reassuring both hesitant patients and healthcare professionals engaging in vaccine counseling. 

In this case-controlled study, researchers reviewed 7849 corneal transplants performed since 2001 to evaluate the association between COVID-19 vaccination and corneal graft rejection. Patients did postoperative care procedures (steroid or antibiotic ophthalmic solution, or both) and were followed up to yearly after transplant. Researchers collected data from January 2018 to December 2021 regarding graft rejections, as well as records on COVID-19 vaccination rates. Patients were considered to have experienced corneal graft rejection if they developed an epithelial rejection line, subepithelial or stromal infiltrates, keratic precipitates, or anterior chamber cell reaction with or without clinically apparent increase in stromal thickness or clarity each year. A Poisson regression model was used to calculate the incidence risk ratio of graft rejection after COVID-19 vaccination.

A total of 1517 patients underwent surgery during the study period with 1252 patients (mean age, 58±19 years; 52.5% men, 47.5% women) having vaccine information. COVID-19 vaccines were delivered to 785 patients. Corneal graft rejection occurred in 38 patients who received a vaccine, with 1 occurring within 60 days from the COVID-19 vaccine. COVID-19 vaccination was not associated with graft rejection in both unadjusted (HR: 0.77 [0.29 – 5.46]; P =.77) and adjusted Cox models (HR: .75 [0.10 – 5.52]; P =.78). Poisson models found no significant increase in incidence rate of rejection in the risk period after COVID-19 vaccination (IRR = 0.56 [0.13 – 2.28]; P =.70)

The data does not support a relationship between COVID-19 vaccines and corneal graft rejection. The risk of rejection is consistent through a person’s lifetime even without a trigger. Corneal graft rejections are reversible with proper management, showing that benefits outweigh the risk of vaccination to protect against COVID-19.

“Although we await more epidemiological data, it is prudent to consider that the apparent temporal relationship between COVID-19 vaccination and corneal graft rejection may not represent a causative association. More importantly, no statistically significant increase in the risk of corneal graft rejection was observed after COVID-19 vaccination,” the researchers report.

The primary limitation of the study was the small sample size which limits the estimable precision of any statistical analysis.