Risk of retinal vascular occlusion following COVID-19 vaccination: A meta-analysis of nearly 15 million individuals

Background: Retinal vascular occlusion is a rare ocular condition reported following coronavirus disease 2019 (COVID-19) vaccination. However, the association between vaccination and retinal vascular occlusion remains uncertain. This systematic review and meta-analysis evaluated the frequency and risk of retinal vascular occlusion following COVID-19 vaccination. Methods: Four electronic databases were systematically searched through August 2026. Observational studies reporting retinal vascular occlusion after COVID-19 vaccination were included. Random-effects meta-analyses were performed to estimate pooled event proportions and risk ratios (RRs) with 95% confidence intervals (CIs). Potentially overlapping study populations were assessed, and study quality was evaluated using the Newcastle–Ottawa Scale. Results: Five studies comprising 14,877,781 reported participants were included. The pooled proportion of retinal vascular occlusion events among vaccinated individuals was 0.02% (95% CI: 0.00%–0.07%; I 2 = 99.5%). The overall association between vaccination and retinal vascular occlusion was not statistically significant (RR = 2.12, 95% CI: 0.65–6.90; P = .213), with substantial heterogeneity ( I 2 = 96.8%). However, separate analyses showed statistically significant associations for retinal artery occlusion (RR = 2.03, 95% CI: 1.17–3.51) and retinal vein occlusion (RR = 2.26, 95% CI: 2.08–2.47), without a significant difference between subtypes ( P = .696). No significant associations between retinal vascular occlusion and vaccine were observed in sex-specific analyses. Among vaccine types, ChAdOx1/AstraZeneca showed a significant association (RR = 2.00, 95% CI: 1.60–2.50), based on a single study, whereas pooled associations for other vaccines were nonsignificant. Conclusion: Retinal vascular occlusion events following COVID-19 vaccination were rare. Although the overall association was not statistically significant, separate arterial and venous analyses showed significant associations. Substantial heterogeneity, potential confounding, and differences in contributing studies limit definitive conclusions. Further research is needed to clarify these findings.