Hyo Song Park MD 1,2∗, Nang Kyeong Lee MS 3∗, Christopher Seungkyu Lee MD, PhD 4, Suk Ho Byeon MD, PhD 4, Sung Soo Kim MD, PhD 4, Seung Won Lee MD, PhD 5†, Yong Joon Kim MD, PhD 4†
1Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Korea
2Department of Ophthalmology, Soonchunhyang University Hospital Bucheon. Bucheon, Korea
3Department of Computer Science and Engineering, Sungkyunkwan University, Suwon, Korea
4The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
5Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
∗Hyo Song Park and Nang Kyeong Lee contributed equally to this manuscript and are considered co-first authors.
†Seung Won Lee and Yong Joon Kim contributed equally to this manuscript and are considered co-corresponding authors.
Corresponding author : Yong Joon Kim MD, PhD
Purpose: To evaluate the incidence of new retinal artery occlusion (RAO) and retinal vein occlusion (RVO) after the diagnosis of coronavirus disease 2019 (COVID-19) or vaccination against COVID-19 and compare the incidences with the population with neither.
Design: Nationwide population-based cohort study PARTICIPANTS: We categorized 8,418,590 patients from a nationwide population-based cohort into control, COVID-19 infection, and COVID-19 vaccination groups.
Methods: We calculated the cumulative incidence of RAO and RVO in Groups 1 (controls), 2 (infection), and 3 (vaccination) using the Kaplan-Meier method. We calculated hazard ratios and 95% confidence intervals (CIs) based on the Poisson distribution for RAO and RVO according to each group and subgroup using Cox proportional hazards models, with Group 1 as the reference. We conducted univariate and multivariate analyses for the risk factors of RAO and RVO according to each subgroup.
Main outcome measures: Cumulative incidence and risks of incidence of RAO and RVO from the index date to day 60.
Results: In multivariable analysis, there was no significant increase in RAO and RVO risks after COVID-19 or COVID-19 vaccination in both men and women. These results were consistently observed across various conditions in sensitivity analyses. In subgroup analysis, individuals who were vaccinated before infection showed no significant increase in RAO and RVO risks in both sexes compared with the control group. In the subgroup analysis of vaccinated patients, the hazard ratios of RAO and RVO for different vaccine types did not show an increase compared with the control group; however, an exception was observed in women who received mRNA-1273 vaccines, who showed a higher RAO hazard ratio (4.65, 95% CI 1.27-17.03, p = 0.021).
Conclusions: RAO and RVO rarely occurred within 60 days of COVID-19 diagnosis or vaccination. We observed no increase in the hazard ratio of RVO and RAO relative to COVID-19 or COVID-19 vaccination except for a possible increase in the RAO hazard ratio in women who received mRNA-1273, for which the raw incidence was extremely low. Further investigation is required to validate this result.