Be mindful of the increased risk of uveitis flare in patients who have received their COVID-19 vaccine. Photo: Michael Trottini, OD. Click image to enlarge.

COVID-19 vaccines are generally safe and their protective effects typically outweigh potential side effects, but certain populations with pre-existing disease should take a more guarded approach. A recent study demonstrated an increased risk of uveitis flare following vaccination. This risk was highest among those with previous recurrence, chronic uveitis and a shorter period of quiescence.

The retrospective study identified participants from the Inflammatory Eye Disease Registry at Auckland District Health Board who were diagnosed with uveitis between January 1, 2010, and December 31, 2020. The date of COVID vaccination was determined from the patient’s clinical record, and the 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 or increased uveitis activity that required a change in treatment.

A total of 4,184 eyes of 3,008 patients were included, with a total of 8,474 vaccinations given during the study period. The median age was 54.8 years, and 1,474 (49%) of the participants were female.

Noninfectious etiology was most common, occurring in 2,296 patients (76.3%), with infectious etiology in 712 (23.7%). The rate of uveitis flare was 12.3 per 1,000 patient months at baseline, 20.7 after the first dose, 15.0 after the second, 12.8 after the third and 23.9 after the fourth. The median period of quiescence prior to flare was 3.9 years. An increase in uveitis flare was seen both in infectious uveitis (13.1 at baseline compared with 20.2 after first dose, 154% increase) and noninfectious uveitis (12.4 at baseline compared with 20.9 after first dose, 169% increase).

Risk factors for uveitis flare were identified to be recurrent uveitis, chronic uveitis, a shorter period of quiescence and the first dose of the COVID-19 vaccine. Median time to uveitis flare was 0.53 months following the first vaccination, 1.74 months following the second and 1.35 months following the third.