Acute Macular Neuroretinopathy Following Moderna mRNA COVID-19 Vaccination

Purpose: The authors report a case of acute macular neuroretinopathy (AMN) following and then exacerbated by mRNA COVID-19 booster vaccination. Methods: Report of a case. Results: A 79-year-old White man presented with a central scotoma in the right eye 2 weeks following administration of his second mRNA COVID-19 vaccination. Optical coherence tomography, fundus autofluorescence and color photography, fluorescein, indocynanine green, and clinical findings were consistent with a diagnosis of AMN. Anatomy and symptoms worsened 8 months later, approximately 2 weeks after the third mRNA COVID-19 vaccine. Improvement in symptoms and findings occurred without therapy 15 months postpresentation. Conclusion: This post-COVID vaccine AMN case is reported following an mRNA vaccine. The chronological relationship to both vaccines, exacerbation after the third vaccine, and occurrence in an older man without the recognized risk factors of non–vaccine-related AMN are compelling for possible causality. Depending on the patient's health and the state of the COVID-19 pandemic with regard to public health, should AMN occur soon after COVID vaccination, clinicians may consider foregoing additional vaccination/boosters or switching to an alternate COVID vaccine vector.