DALK rejection following vaccination against SARS-CoV-2: 2 case reports.

PURPOSE: To report two cases of deep anterior lamellar keratoplasty (DALK) rejection occurring in association with SARS-CoV-2 vaccination.

METHODS: Two patients with prior history of DALK developed immunologic rejection after SARS-CoV-2 vaccination. The first patient, a 15-year-old girl, had a stromal and sub-epithelial rejection nine days after receiving the first dose of the SARS-CoV-2 vaccine BBV152(COVAXINTM , Bharat Biotech, India). The second patient, an 18-year-old male, had a stromal rejection 13 days after receiving the second dose of the ChAdOx1 SARS-CoV-2 vaccine (COVISHIELDTM , Serum Institute of India, India).

RESULTS: Both patients received frequent topical corticosteroids. The first patient recovered within four weeks and the second patient recovered within two weeks of initiating therapy. Both patients experienced complete resolution of corneal edema and had improvement in their visual acuity.

CONCLUSIONS: DALK rejection is a rare but distinct possibility in patients following SARS-CoV-2 immunization. Further studies are required before establishing clear guidelines regarding risk, follow-up and treatment strategies in such a scenario.