Study Finds Uveitis Recurrence After COVID-19 Vaccine in Individuals with History: JAMA Ophthalmology Report

People with a history of uveitis may have a recurrence of the ocular inflammatory disorder after receiving the COVID-19 vaccine, especially in the early post-vaccination period.

A study recently published in JAMA Ophthalmology found that about 17% of nearly 474,000 vaccinated individuals with a history of uveitis had a recurrence within a year of vaccination.

Uveitis (inflammation of the hollow tunic of the eye called the uvea or choroid) occurs when the immune system fights infection or attacks healthy tissue in the eye. This can cause symptoms including pain, redness and loss of vision as it affects the uvea and other parts of the eye.

Researchers collected data on all people diagnosed with uveitis in South Korea between January 2015 and February 2021 to determine their risk of recurrence after receiving the COVID-19 vaccine get The data were taken from the databases of the Korea National Health Insurance Service and the Korea Disease Control and Prevention Agency. The incidence of uveitis was analyzed from February 26, 2021 to December 31, 2022. Cases were classified according to onset at three months, six months, and one year, the type of uveitis, and the type of vaccine.

Individuals included in the study received at least one dose of the COVID-19 vaccine from Pfizer, Moderna, AstraZeneca, or Johnson & Johnson and did not test positive for SARS-CoV-2 during the investigation.

Research findings

Among the 473,934 people included in the study, the cumulative incidence of post-vaccination uveitis was 8.6% at three months, 12.5% ​​at six months and 16.8% at one year – in most some of the former type, affecting the iris from the front of the eye. In addition, the risk of uveitis recurrence was highest in the first 30 days after vaccination, peaked between the first and second doses of vaccine, and decreased with vaccinations after that.

According to the researchers, the first dose of the vaccine can activate the inflammatory pathways that cause initial inflammation in people who are prone to autoimmune reactions or have a history of uveitis. However, there is a reduction in risk with repeated vaccination, which may be due to the adaptation of the immune system to the vaccine antigen, although further studies are needed to confirm this idea.

In addition, the risk of experiencing the condition increased among those who received all four types of vaccines, especially among those who received Pfizer’s COVID-19 vaccine. These patients were more likely to experience uveitis again during the initiation period. Also, those who received the Moderna vaccine showed a higher risk of developing uveitis after the first vaccination and in the early onset period.

Notably, there were differences in the types of uveitis seen in the pre- and post-vaccination periods. Among patients with infectious uveitis before receiving the COVID-19 vaccine, nearly 54% had non-infectious uveitis after vaccination, and the majority of people with non-infectious uveitis before vaccination had same type again after vaccination.

Most patients with uveitis were between 60 and 79 years old, followed by those between 40 and 59 years old. Among those with comorbidities, hypertension, diabetes and rheumatic diseases were the most common.

“Although post-vaccination uveitis is rare, our findings support an increased risk after vaccination against COVID, especially in the early post-vaccination period,” the authors wrote. “These findings underscore the importance of vigilance and monitoring of uveitis in the context of vaccines, including vaccines against COVID, especially in people with a history of of uveitis.”

Other studies of vaccine-associated uveitis

Other studies have found a link between uveitis and the COVID-19 vaccine, including a February 2023 study published in the journal Ophthalmology. The study provided information on a possible temporal link between reported vaccine-related events and Covid vaccines from Pfizer, Moderna and Johnson & Johnson.

In addition, they were reported adverse eye reactions after the COVID-19 vaccine, in addition to uveitis, including facial nerve palsy, retinal vascular occlusion, acute macular neuroretinopathy, thrombosis and Graves’ disease.

In an article published in June 2022 in Journal of vaccinesresearchers analyzed adverse ocular reactions reported to the Vaccine Adverse Event Reporting System (Vaccine Adverse Event Reporting System / VAERS) to provide doctors and researchers with a broader picture of the ocular effects of COVID-19 vaccines.

VAERS is a voluntary reporting system jointly administered by the US Food and Drug Administration.Food and Drug Administration / FDA) and the Center for Disease Control and Prevention (CDC). It is designed to detect signs of vaccine safety, although it is estimated to account for less than 1% of serious adverse events.

During the study period from December 2020 to December 2021, VAERS received 55,313 reports of ocular adverse events, of which 6,688 met inclusion criteria. Of these reports, 2,229 were related to eye inflammation, ocular hyperemia (eye redness), and conjunctivitis, 1,785 were reports of blurred vision, and 1,322 were reports of impaired vision.

Women accounted for 74 percent of the reports, and the eye condition occurred mostly in people aged 40 to 59 who received the Johnson & Johnson or Moderna vaccine.

Of the patients who reported eye problems, 50% received the vaccine against COVID-19 from Pfizer, 38% from Moderna, and 12% from Johnson & Johnson.

Although the study’s authors said they could not determine whether the vaccines were associated with an increased risk of severe reactions, their data suggest “a possible link between the COVID vaccines -19 and adverse eye events. “

“Physicians are cautioned not only to be aware of this potential problem, but also to screen for underlying medical conditions in patients and carefully register in VAERS within several weeks after vaccination,” they wrote.

According to current VAERS data, 734 in cases of uveitis, 539 cases swelling of the eyes, 2,781 cases of retinal disorders, 11,641 cases disorders of the facial nerve and 3,909 reports of eyelid inflammation, ocular hyperemia and conjunctivitis reported after vaccination with the anti-COVID vaccines between 14 December 2020 and 29 March.

Possible links between uveitis and other vaccines, including vaccines against influenza, human papilloma virus and varicella-zoster virus. However, these studies did not necessarily establish a causal relationship.