Reactivation of Herpetic Keratitis by Mixing and Matching Coronavirus Disease 2019 (COVID-19) vaccines in Taiwan: A Retrospective Analysis

Abstract

Abstract Background As an increasing population has received different kinds of COVID-19 vaccines, many ocular adverse events have been reported. The objective of this study is to evaluate the association between COVID-19 vaccines and the activation of herpetic keratitis. Methods Patients presented with any type of herpetic keratitis after mixing and matching COVID-19 vaccinations was enrolled. A descriptive analysis of the demographics, clinical history and ocular presentation in these patients was performed. Results A total of 16 patients including 6 (37.5%) males and 10 (62.5%) females receiving COVID-19 vaccines between 2021 to 2022 were included. The mean age at evaluation was 59.4 ± 15.4 years. Of the 16 patients, 9 (56.3%), 2 (12.5%), 5 (31.3%) of them presented with stromal keratitis, epithelial keratitis and herpes zoster ophthalmicus respectively. Among 8 recurrent cases, the COVID-19 vaccine-related attacks presented severer in 1 (12.5%) patient, equally severe in 2 (25%) patients, and less severe in 5 (62.5%) patients compared to previous infection. Interestingly, 6 (37.5%) patients developed an initial symptomatic herpetic keratitis attack after mixing and matching (COVID-19) vaccination. All of them received oral famciclovir with or without topical steroid eyedrops soon after diagnosis. The majority of them reported no further complication. Conclusions In conclusion, this study demonstrated a possible association between COVID-19 vaccination and primary herpetic infection or reactivation. Early diagnosis and appropriate management help reduce the severity of the disease.