Acute macular neuroretinopathy following Moderna COVID-19 vaccination

Abstract

Purpose: To describe the occurrence of an acute macular neuroretinopathy (AMN) after administration of a Moderna COVID-19 Vaccine. Methods: Case report. Results: A 23-year-old female presented bilateral visual loss one week after the first dose of COVID-19 vaccine. Fundus examination revealed the classic wedge-shaped lesions with petaloid configuration around both foveas. Hypo-reflective macular lesions are evident in the near-infrared reflectance image. The spectral-domain optical coherence tomography reveled hyperreflectivity of the outer nuclear and plexiform layers, attenuation of the ellipsoid zone and disruption of interdigitation zone corresponding to the lesions. Conclusions: Despite the large number of doses of COVID-19 vaccines administered worldwide, there are not many reported cases of AMN. Most of them occurred after viral vector vaccines. Described here is one of the few cases that observed a time period of several days after receiving the Moderna messenger RNA vaccine. It is not possible to establish causality although this suggests an inflammatory or autoimmune response to the vaccine.