Optic neuritis associated with COVID-19-related vaccines

Keikha, Masoud; Zandhaghighi, Mehdi; Zahedani, Shahram Shahraki
doi:10.1016/j.vacun.2022.12.002
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">There were more than 634&#44;754&#44;573 COVID-19-infected cases and 6&#44;609&#44;414 global deaths from SARS-CoV-2 infection by November 2022&#44; as the severe acute respiratory syndrome coronavirus 2 &#40;SARS-CoV-2&#41; pandemic continues to spread worldwide&#46; It is imperative in this case to create effective SARS-CoV-2 vaccinations as a strategy to lessen the severity of the illness and subsequent deaths&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> Adenoviral vectors &#40;AstraZeneca and Janssen&#41;&#44; messenger RNA &#40;m-RNA&#41;-based vaccines &#40;Pfizer and Moderna&#41;&#44; and inactivated virus are three vaccine categories that have been approved by the World Health Organization to prevent SARS-CoV-2 illness &#40;as Sinovac&#41;&#46; In phase 3 randomized studies&#44; these vaccine doses were not associated with significant adverse effects&#46;<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> However&#44; given the substantial side effects associated with COVID-19 vaccinations and the quick and extensive clinical use of these vaccines&#44; they must be further evaluated&#46; Another issue that continues to be difficult is the clinical effectiveness of SARS-CoV-2 vaccinations in immune-compromised people&#46;<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">Early observations indicate that COVID-19 infection causes ocular symptoms via both direct invasion and indirect immune-mediated processes&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> In this respect&#44; it is known that SARS-CoV-2-infected people have ocular symptoms like conjunctivitis&#44; scleritis&#44; orbital inflammation&#44; keratitis&#44; and retinal damage&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> However&#44; after receiving the COVID-19 vaccine&#44; reports of neuro-ophthalmic symptoms have been made&#46; The literature states that after receiving the COVID-19 vaccine&#44; ocular issues involving the ophthalmic uvea&#44; optic nerve&#44; retina&#44; orbit&#44; cornea&#44; and retinal vessels&#44; as well as cranial nerve palsies &#40;such as those affecting the oculomotor&#44; abducens&#44; and facial nerves&#41;&#44; have emerged&#46;<a class="elsevierStyleCrossRefs" href="#bb0030"><span class="elsevierStyleSup">6&#8211;8</span></a> Additionally&#44; after receiving the SARS-CoV-2 vaccine&#44; optic neuritis&#44; an uncommon demyelinating effect&#44; has been reported&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">Historically&#44; following various vaccinations&#44; central demyelinating symptoms together with additional optic neuritis&#44; acute transverse myelitis&#44; and even acute disseminated encephalomyelitis are frequently documented&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> According to research from England&#44; syphilis &#40;OR&#58; 5&#46;76&#41;&#44; mycoplasma &#40;OR&#58; 3&#46;90&#41;&#44; and the Epstein&#8211;Barr virus &#40;OR&#58; 2&#46;3&#41; are infectious diseases that are correlated with ocular neuritis&#46;<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a> However&#44; after receiving the COVID-19 vaccine&#39;s priming dosage&#44; there was an uncommon cluster of severe optic neuritis in UK populations&#44; which was at odds with the epidemiological trends of the previous 22&#8239;years&#46; According to Petzold et al&#46;&#39;s review of the neurological adverse effects linked to COVID-19 post-vaccination in the UK&#44; 85 cases of optic neuritis following COVID-19 vaccination had acceptable reviews following treatment&#46;<a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a> In Taiwan&#44; Lee and colleagues reported the first case of optic neuritis after a second vaccination with OxfordAstraZeneca&#44; stating that early detection and treatment may help to stop demyelinating progression in those cases<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a>&#59; Optic neuritis has reportedly occurred following administration of different COVID-19 vaccines&#44; such as mRNA-1273&#44; BNT162b2&#44; or Ad26&#46;COV2&#46;S&#44; according to the literature&#46; Historically&#44; influenza&#44; anti-rabies&#44; HPV&#44; and other vaccines have all been linked to optic neuritis&#46; In conclusion&#44; vaccine-induced optic neuritis is an unfortunate side effect&#44; but it seldom manifests&#46;<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a> It appears that vaccines and their adjuvants help to induce a strong immune response&#46; As a result&#44; ophtalmic nervous system injuries may occur following reactivation&#46;<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a> However&#44; the absence of adjuvants in some of COVID-19 vaccines on the one hand&#44; and the occurrence of autoimmune reactions &#40;It is the same as in adjuvant-containing vaccines&#41; on the other hand remains a mystery&#46;<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a> There are some indications that the COVID-19 vaccine caused anti-CD20 antibodies to be produced and elevated&#46;<a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a> Furthermore&#44; earlier research suggested that the susceptibility to ocular neuropathies following immunization may be due to an autoimmune mechanism&#46; In this regard&#44; research has demonstrated that post-vaccination optic neuropathy is linked to molecular mimicry&#44; which causes neutralizing antibodies against the SARS-CoV-2 spike protein to cross-react with components of the central nervous system&#44; particularly the optic nerve&#46;<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a> As a result&#44; the condition may also be caused by synergistic interactions involving the autoimmune response&#44; endothelial dysfunction&#44; and comorbidities such as younger age&#44; gender&#44; diabetes&#44; or hypertension&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">According to recent cohort data&#44; there is a clear difference between COVID-19 vaccine-induced optic neuritis and prior conventional optic neuritis in terms of disease severity&#44; bilateral presentation&#44; age&#44; gender&#44; and even radiological appearances&#46; AstraZeneca &#40;ChAdOx1&#41; was given to a large number of people who had no prior evidence of neuro-inflammation&#46;<a class="elsevierStyleCrossRef" href="#bb0085"><span class="elsevierStyleSup">17</span></a> Paybast et al&#46;&#44; 2022&#44; recently reported six individuals with neuromyelitis optica spectrum disease who developed optic neuritis six days after receiving the COVID-19 vaccine&#46; Two doses of the COVID-19 vaccine were administered to more than 90&#37; of the subjects&#44; 83&#46;3&#37; of whom were female and had numerous comorbid conditions &#40;77&#37;&#41; prior to treatment&#46;<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a> The most common ophthalmic neurophaties linked to the SARS-CoV-2 vaccines were also reported by Elnahry and colleagues&#46; They discovered that all COVID-19 vaccines can cause ophthalmic manifestations like anterior ischemic optic neuropathy &#40;AION&#41;&#44; optic neuritis &#40;ON&#41;&#44; autoimmune optic neuropathy&#44; and leber hereditary optic neuropathy &#40;LHON&#41;&#46; This study suggested that after 9&#46;6&#8239;&#177;&#8239;8&#46;7&#8239;days&#44; younger fetuses were affected by opthalmic-related adverse outcomes&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a></p><p id="p0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; the majority of populations tolerate the SARS-CoV-2 vaccination types well&#46; However&#44; there were some negative side effects&#44; notably in people with neuromyelitis optica spectrum conditions&#44; such as mild optic neuritis&#46; The clinical advantages of receiving the COVID-19 vaccine far exceed the hazards&#46; Optic neuritis has unique symptoms and&#44; in the majority of cases&#44; resolves on its own without special care&#46; Therefore&#44; more extensive research is required to address the true prevalence of ocular neuropathies linked to COVID-19 immunization&#46;</p><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Conflict of interest</span><p id="p0030" class="elsevierStylePara elsevierViewall">Nil&#46;</p></span></span>"
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