COVID-19 Vaccine–Associated Uveitis in Patients With a History of Uveitis

Abstract

ImportanceUnderstanding the potential risk of uveitis recurrence after COVID-19 vaccination in individuals with a history of uveitis is crucial for vaccination strategies and clinical monitoring.ObjectiveTo investigate the risk of uveitis recurrence after COVID-19 vaccination in a cohort of individuals with a history of uveitis.Design, Setting, and ParticipantsThis retrospective population-based cohort study included individuals diagnosed with uveitis between January 1, 2015, and February 25, 2021, in South Korea. After excluding individuals without COVID-19 vaccination or with SARS-CoV-2 infection, individuals with a history of uveitis who had received at least 1 dose of a messenger RNA (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) or adenovirus vector-based (ChAdOx1 [AstraZeneca] or Ad26.COV2.S [Janssen]) COVID-19 vaccine were included. Data were analyzed from February 26, 2021, to December 31, 2022.ExposureDemographic and clinical data, along with vaccination details, were retrieved from the Korean National Health Insurance Service and Korea Disease Control and Prevention Agency databases.Main Outcomes and MeasuresOutcomes of interest were incidence and risk of postvaccination uveitis in association with different COVID-19 vaccines and periods before and after COVID-19 vaccination. Uveitis was categorized by onset (early, within 30 days, or delayed) and type (anterior or nonanterior). Hazard ratios (HRs) with 95% CIs were calculated to evaluate the risk of uveitis following COVID-19 vaccination, stratified according to vaccine type and vaccination period.ResultsOf 543 737 individuals with history of uveitis, 473 934 individuals (mean [SD] age, 58.9 [17.4] years; 243 127 [51.3] female) had documented COVID-19 vaccination and were included in analysis. The cumulative incidence of postvaccination uveitis was 8.6% at 3 months, 12.5% at 6 months, and 16.8% at 1 year, predominantly of the anterior type. Variations in the risk of postvaccination uveitis were observed across different vaccines and intervaccination periods. The risk of early postvaccination uveitis was increased for individuals receiving the BNT162b2 (HR, 1.68; 95% CI, 1.52-1.86), mRNA-1273 (HR, 1.51; 95% CI, 1.21-1.89), ChAdOx1 (HR, 1.60; 95% CI, 1.43-1.79), and Ad26.COV2.S (HR, 2.07; 95% CI, 1.40-3.07) vaccines. The risk of uveitis was higher particularly between the first and second vaccination doses (HR, 1.64; 95% CI, 1.55-1.73).Conclusions and RelevanceThese findings suggest that there was an elevated risk of uveitis following COVID-19 vaccination, with the vaccine type and period mediating this risk. For individuals with a history of uveitis, clinicians should consider the potential risk of uveitis recurrence in vaccination strategies and clinical monitoring.

Risk of Post-COVID-19 Uveitis and Risk Modification by Vaccination: A Nationwide Retrospective Cohort Study

“…Misclassification bias may be another important limitation of population-based studies using health-claim databases [ 21 ]. The post-vaccination period might be heterogeneous in terms of uveitis risk, owing to subsequent vaccinations, despite having a smaller effect than the first one in previous studies [ 12 , 13 , 16 ]. However, the post-vaccination period in this study, rather than the post-first vaccination or post-second vaccination period, is simple and straightforward and represents the effect of the most significant event in terms of vaccine-associated uveitis, the first vaccination.…”

“…Uveitis types were classified as anterior or non-anterior and as infectious or non-infectious using the relevant KCD-8/ICD-10 codes, consistent with previous studies on the same database (NHIS). The definitions and specific codes used for this study are outlined in Supplementary Table S1 [ 13 , 14 , 15 ].…”

“…Previous studies have provided insights into the relationship between COVID-19 and uveitis. While some have reported uveitis to be one of the most common complications of COVID-19 infection [ 7 , 8 ], others have reported post-vaccination cases as well [ 9 , 10 , 11 , 12 , 13 ]. Among these studies, several population-based ones revealed an association between COVID-19 vaccination and uveitis [ 10 , 12 , 13 ].…”

“…While some have reported uveitis to be one of the most common complications of COVID-19 infection [ 7 , 8 ], others have reported post-vaccination cases as well [ 9 , 10 , 11 , 12 , 13 ]. Among these studies, several population-based ones revealed an association between COVID-19 vaccination and uveitis [ 10 , 12 , 13 ]. However, discerning the distinct effects of COVID-19 infection and vaccination on uveitis recurrence remains a challenge, necessitating further research to disentangle these complex relationships, especially considering the substantial overlap between vaccinated individuals and those who subsequently become infected.…”