COULD ACUTE CORNEAL ENDOTHELIAL GRAFT REJECTION BE A POST-COVID CONDITION?: A CASE REPORT

Published 2022 - 26th ESCRS Winter Meeting

Reference: P191 | Type: Abstracts | DOI: 10.82333/4kaj-q628

Authors: Peter Pego* ¹ , Bernardo Feijoo ² , Filomena Ribeiro ³

¹Vision Center - Ophthalmology department,Hospital da Luz,Lisbon,Portugal;Medical School,University of Lisbon,Lisbon,Portugal;Institute for Environmental Health,University of Lisbon,Lisbon,Portugal, ²Vision Center - Ophthalmology Department,Hospital da Luz,Lisbon,Portugal, ³Vision Center - Ophthalmology department,Hospital da Luz,Lisbon,Portugal;Medical School,University of Lisbon,Lisbon,Portugal;Visual Sciences Research Center,University of Lisbon,Lisbon,Portugal

Purpose

To report a case of acute corneal endothelial graft rejection 5 weeks after the diagnosis of coronavirus disease 2019 (COVID-19)

Setting

Ophthalmology Department

Methods

Case report

Results

A 30-year-old Caucasian man with a history of bilateral keratoconus and no other health problems developed acute corneal endothelial graft rejection 11 months after uncomplicated penetrating keratoplasty of the left eye. Five weeks earlier, he was diagnosed with COVID-19 but had no symptoms at the time. He was complying to topical corticosteroids therapy, as prescribed, and denies any other type of complication that could explain the rejection of the corneal graft. Six weeks after starting aggressive therapy with topical and oral corticosteroids and hypertonic drops of sodium chloride, there was reversal of endothelial rejection with improvement in corneal transparency, visual acuity and number of endothelial cells.

Conclusion

There are reports of acute corneal graft rejection, either in patients in the acute phase of COVID-19 or after vaccination against COVID-19. Post-COVID conditions is a term used for a wide range of health consequences that are present four or more weeks after infection with COVID-19 and can occur in patients who have had varying degrees of illness including those who had mild or asymptomatic infections. Multiorgan system effects of COVID-19 have been documented in most, if not all, body systems including cardiovascular, pulmonary, renal, dermatology, neurology, and ophthalmology. Some studies reveal that post-COVID may be detectable in the eyes of patients, in the form of nerve damage and increase in dendritic cells density that can be seen in the cornea. These migration and accumulation of dendritic cells in the central cornea is consistent with an innate immune and inflammatory process that could result in acute corneal graft rejection. Clinicians and researchers are still in the early stages of understanding post-COVID conditions and it can be difficult to distinguish symptoms caused by post-COVID conditions from symptoms that occur for other reasons. As far as we know, this is the first report of a case of acute corneal graft rejection that could be the presentation of a post-COVID condition.