Risk of Recurrent Non-Infectious Uveitis after COVID-19 Vaccination in the United States

PurposeTo date, many case reports have detailed the recurrence of non-infectious uveitis (NIU) following COVID-19 vaccinations, contributing to vaccine hesitancy in patients with a history of NIU. This study aimed to evaluate the association between COVID-19 vaccination and risk of recurrent NIU in those with a prior history of the disease between December 11, 2020 and January 31, 2022.DesignSelf-controlled case series (SCCS) analysis using Optum Labs Data Warehouse (OLDW), a national de-identified healthcare claims database in the United States with administrative claims and electronic health record data.ParticipantsPatients continuously enrolled in OLDW at least 730 days prior to December 11, 2020 who received a COVID-19 vaccination and experienced a NIU event within the study period. Enrollees without a NIU event before the study period were excluded.MethodsIncidence rate ratios (IRR) comparing NIU incidence in exposed post-vaccine risk periods and unexposed control periods within an individual were calculated using conditional Poisson regression models. Subgroup analyses were conducted by vaccination type, age group, and use of immunomodulatory therapy.Main Outcome MeasuresRates of NIU identified with International Classification of Disease 10th (ICD-10) revision codes.Results412 patients were included in the SCCS analysis (mean age [SD] = 51.5 [15.1] years, 60.7% female). 209 NIU outcomes were identified in post-vaccine risk intervals spanning 111 cumulative person-years; 203 NIU outcomes were identified in unexposed control intervals, which spanned 184 person-years cumulatively. The IRR comparing post-vaccine risk to risk in the control intervals adjusted for time since NIU flare was 1.29 (95% CI: 1.02-1.62, p = 0.03).ConclusionsThere was an increased risk of NIU post-vaccination in patients with a prior history of the disease, which may be due to immune activation from vaccination. This finding merits further study and may have clinical implications for this population, including the need for post-vaccination monitoring.