Macular and retinal manifestations following COVID-19 vaccinations: a 2025 update systematic review and meta-analysis.

An increasing number of reports have linked COVID-19 vaccination to ocular complications, including retinal vascular occlusions, inflammatory disorders, and neuro-ophthalmic events. However, the spectrum and temporal associations of these ocular complications are not adequately understood. This study aims to characterise the types of retinal and macular complications, evaluate latency patterns, and assess the associations with COVID-19 vaccination from 2020 to 2025. We conducted a systematic review and meta-analysis according to the PRISMA 2020 guidelines. Studies reporting retinal or macular complications post-COVID-19 vaccination were searched via Ovid MEDLINE, Embase, and the Cochrane Library. Extracted data included study demographics, outcome, latency, and vaccine subtype. The risk of bias was assessed, and a random-effects meta-analysis was performed to estimate the pooled relative risk of ocular complications following vaccination. A total of 173 studies were included, with the most frequently reported outcome being retinal vascular occlusions (n = 107). The distribution of ocular complications was significantly different between COVID-19 vaccine and infection exposure (p = 0.014). Most complications occurred within the first month of exposure, particularly among mRNA vaccines, which had a significantly different adverse event rate across vaccine platforms (p = 0.0084). A meta-analysis resulted in a pooled relative risk of 2.40 (95% CI: 0.33-17.73) for retinal vein occlusion following vaccination; however, due to the uncertainty around the estimate, the association remains inconclusive. These findings support considering COVID-19 vaccination as a potential differential cause for patients with retinal vascular occlusions, highlighting the need for continued vaccine safety and surveillance.