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  • Uveitis associated with SARS-CoV-2 vaccination is a rare adverse event

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    Review of: Vaccine-associated uveitis after COVID-19 vaccination

    Singh R, Parmar U, Kahale F, et al. Ophthalmology, February 2023

    Using data from the Centers for Disease Control and Prevention Vaccine Adverse Event Reporting System (CDC VAERS) program, investigators conducted a retrospective study to assess the prevalence of vaccine-associated uveitis (VAU) after SARS-CoV-2 vaccination.

    Study design

    Patients diagnosed with VAU who received one of the 3 FDA-authorized emergency-use vaccines between December 11, 2020, and May 9, 2022, were included in the study. Data were reported from 40 countries, including the United States. The main outcome measures were estimated global crude reporting rate, observed-to-expected ratio of VAU in the United States, associated ocular and systemic presentations, and onset duration.

    Outcomes

    More than 206 million doses of the 3 vaccines were administered. There were 1094 reports of VAU, with estimated crude reporting rates of 0.35–0.57 per million doses. While 78% of VAU cases were reported in patients who received the BNT162b2 (Pfizer) vaccine, the observed-to-expected ratio of VAU was comparable for each of the 3 vaccines. The majority of VAU cases were anterior uveitis, and there was a similar proportion of anterior, posterior, and panuveitis among all 3 vaccines. The most common systemic findings reported in the VAU cases were fever, headache, mucosal ulcerations, and arthritis.

    Limitations

    There are several limitations to this study. The CDC VAERS is a passive surveillance program that relies on reporting of adverse events; therefore, submissions may be incomplete, lacking, or the events not reported at all. As this was a retrospective study, there was no unvaccinated control group to assess a relative risk for VAU. Also, this study only suggests a temporal association between uveitis and SARS-CoV-2 vaccination, but does not prove causality.

    Clinical significance

    This study reports that VAU associated with SARS-CoV-2 vaccination appears to be a rare adverse event. Patients with a history of uveitis may be on immunosuppressive therapy; therefore, one could infer that the risk of negative sequelae from SARS-CoV-2 infection in an immunocompromised patient is higher than the risk of developing VAU.

    Financial Disclosures: Dr. Jessica Weinstein discloses no financial relationships.