Survey gauges corneal surgeons’ attitudes regarding keratoplasty and vaccines

Although graft rejection has not been associated with vaccinations, concern remains.

A recent survey on the prevailing attitudes of corneal surgeons about the advice given to patients regarding common vaccinations and the effects on the most common keratoplasty procedures found that roughly half of the responding surgeons do not alter their management of keratoplasty and advice about zoster and/or influenza vaccinations for fear of graft rejection.

The survey also found that while graft rejection has not been associated with vaccinations, concern remains, according to lead study author David Lockington, MD, FRCOphth, PhD, from Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland.

These surgeons’ attitudes were gleaned from the data collected from an online questionnaire that was posted on the Kera-net listserv and the EuCornea Web site early in 2020. The questionnaire explored the surgeons’ attitudes about the herpes zoster and influenza vaccinations and their decision-making regarding performing endothelial keratoplasty, deep anterior lamellar keratoplasty, and penetrating keratoplasty and the risk of vaccine-associated graft rejection.

Attitudes regarding keratoplasty and vaccines

Among the 142 surgeons who responded to the questionnaire, 51.1% advised their patients who underwent a keratoplasty procedure to get all the vaccinations.

About 20% of the responders reported that they had clinical experience of a graft rejection associated with a vaccine, and about 42% did not have such an experience of which they were aware.

Almost two-thirds of surgeons advised patients to delay undergoing vaccination in they were within 3 months from a keratoplasty; 64% of those concerned would recommend delayed vaccination in the following scenarios: if it was within 3 months of transplant surgery, if they had had a recent corneal infection, or if they had had a recent graft rejection.

Generally, the investigators reported, “The 2,245 total responses to 18 clinical scenarios demonstrated wide variability in management of grafts in the setting of vaccination. Generally, 45.9% would not alter management, 26.2% would increase the frequency of topical steroids, and 22.2% would recommend delayed vaccinations. Increased concern was expressed with recent surgery, live zoster vaccine, and higher-risk penetrating keratoplasty scenarios.”

The key take-home messages were that about half of the surgeon responders do not change their management approach regarding keratoplasty and zoster and/or influenza vaccinations, anecdotal episodes of graft rejection that may have been associated with vaccinations were reported by some, and vaccine-related rejections have not been reported in higher-level research but clinical concerns remain, nevertheless.

Finally, prospective research to determine the actual vaccine-related risks in keratoplasty is needed for the development of evidence-based management guidelines and for surgeons to provide patients with definitive reassurance about the effects of vaccinations on keratoplasty.

Reference
  1. Lockington D, Lee B, Jeng BH, et al. Survey of corneal surgeons' attitudes regarding keratoplasty rejection risk associated with vaccinations. Cornea. 2021;40:1541-7; doi: 10.1097/ICO.0000000000002662