Navigating Coronavirus Disease 2019 Vaccination and Uveitis: Identifying the Rates and Risk of Recurrent Uveitis after Coronavirus Disease Vaccination

Abstract

To identify rates of uveitis reactivation both prior and following the COVID-19 vaccine in subjects with a previous diagnosis of uveitis. Retrospective study. Subjects were identified from the Inflammatory Eye Disease Registry at Auckland District Health Board diagnosed with uveitis between 1st January 2010 and 31st December 2020. Date of COVID vaccination was determined from the patient clinical record. Rate of flare was calculated for three months prior to vaccination and for three months after each vaccination. Uveitis flare was defined as the presence of new uveitis activity or increased activity that required a change in uveitis treatment. 4,184 eyes of 3,008 patients were included in the study with a total of 8,474 vaccinations given during the study period. Median age was 54.8 years and 1,474 (49.0%) were female. Non-infectious etiology was most common, occurring in 2,296 patients (76.3%) and infectious etiology in 712 (23.7%). Rate of uveitis flare was 12.3 per 1,000 patient months at baseline, 20.7 after first dose, 15.0 after second dose, 12.8 after third dose and 23.9 after fourth dose. Median period of quiescence prior to flare was 3.9 years.An increase in uveitis flare was seen both in infectious uveitis (baseline 13.1 compared to 20.2 after first dose, 154% increase) and for non-infectious uveitis (baseline 12.4 compared to 20.9 after first dose, 169% increase). Risk factors for uveitis flare were identified to be recurrent uveitis, chronic uveitis, shorter period of quiescence and first dose of vaccine. Median time to uveitis flare was 0.53 months following the first vaccination, 1.74 months following second vaccination, and 1.35 months following the third vaccination. The current study demonstrates an increased risk of uveitis flare following first dose of COVID vaccination. This risk was highest in those with previous recurrences, chronic uveitis, and shorter period of quiescence.