UVEITIS AFTER THE BNT162b2 mRNA VACCINATION AGAINST SARS-CoV-2 INFECTION

Abstract

Purpose: To describe uveitis cases after the BNT162b2 mRNA SARS-CoV-2 vaccination.Methods: This is a multicenter, retrospective study. Vaccine-related uveitis diagnosis was supported by the classification of the World Health Organization Adverse Drug Terminology and the Naranjo criteria.Results: Twenty-one patients (23 eyes) with a mean age of 51.3 years (23-78 years) were included. Eight of the 21 patients had a known history of uveitis. The median time from previous to current attack was 1 year (0.5-15 years). There were 21 anterior uveitis cases, two with bilateral inflammation. Eight cases occurred after the first vaccination and 13 after the second vaccination. All but three presented as mild to moderate disease. Two patients developed multiple evanescent white dot syndrome after the second vaccination. The mean time from vaccination to uveitis onset was 7.5 ± 7.3 days (1-30 days). At final follow-up, complete resolution was achieved in all but two eyes, which showed significant improvement. One case of severe anterior uveitis developed vitritis and macular edema after the second vaccination, which completely resolved after an intravitreal dexamethasone injection.Conclusion: Uveitis may develop after the administration of the BNT162b2 mRNA vaccine. The most common complication was mild to moderate anterior uveitis, while multiple evanescent white dot syndrome can also occur less frequently.

COVID-19 Vaccination and The Eye

“…COVID-19 vaccine-associated uveitis has been reported in 27 cases in the peerreviewed literature to date (Table 1), with onset ranging from 1 to 30 days following vaccine administration. [23][24][25][26][27] Twenty-five of the 27 cases received the recombinant mRNA BNT162b2 (Pfizer/ BioNTech) vaccine, while the remaining 2 cases received the adenovirus vector ChAdOx1 nCoV-19 (AstraZeneca) and inactivated virus BBIBP-CorV (Sinopharm) vaccines, respectively. Seventeen cases developed uveitis following the second dose, eight cases following the first dose, while dose administration details were not available for the remaining two cases.…”

Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare

“… 112–114 In a multi-center study of 23 eyes of 21 patients that developed an acute episode of uveitis after the BNT162b2 vaccine (Pfizer), 8 patients (38%) had a known history of uveitis, the median time to onset was approximately 8 days, and most patients (86%) had mild to moderate anterior uveitis that significantly improved with topical therapy or intravitreal steroids. 115 The authors suggested that the vaccine may have triggered a type I interferon secretion, leading to an autoimmune reaction. 115 There have also been case reports of acute corneal graft rejections occurring after vaccination, which may be due to allorecognition by the direct pathway or incitation of the antibody response; fortunately, most rejection episodes resolved with topical and/or systemic steroids.…”

“… 115 The authors suggested that the vaccine may have triggered a type I interferon secretion, leading to an autoimmune reaction. 115 There have also been case reports of acute corneal graft rejections occurring after vaccination, which may be due to allorecognition by the direct pathway or incitation of the antibody response; fortunately, most rejection episodes resolved with topical and/or systemic steroids. 105 , 112 , 116–120 Physicians may therefore consider reviewing the potential signs of graft rejection with corneal transplant recipients in order to improve earlier detection and treatment.…”

Multiple evanescent white dot syndrome following vaccination for COVID-19

“…Several inflammatory events other than MEWDS have been reported after COVID-19 vaccination. Rabinovitch et al [ 2 ] described 19 patients with anterior uveitis (2 with bilateral inflammation) that developed after vaccination with BNT162b2 mRNA, with 8 cases occurring after the first vaccination and 11 cases after the second vaccination. In our case, bilateral inflammation of the anterior segment was observed, manifested by an increased flare in the anterior chamber.…”