Background: Uveitis is a sight threatening disease caused by inflammation of the uveal tract of the eye. Uveitis is a manifestation of many autoimmune conditions and is associated with seronegative axial spondyloarthritis, reactive arthritis, Behçet’s disease, inflammatory bowel disease, and psoriatic arthritis. Acute anterior uveitis is the most common presentation and is most commonly idiopathic or associated with the HLA-B27 gene (around 20% of cases). Studies have shown that anterior uveitis frequently recurs in patients after it has previously remitted. (1) Patients suffering from autoimmune conditions are frequently prescribed immunosuppressant drugs to control their illness, thus leaving them more susceptible to bacterial and viral illnesses including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Previous studies have shown that some patients suffer exacerbation of their autoimmune condition after coronavirus vaccination, including uveitis(2). We aim to evaluate our cohort of patients suffering from autoimmune conditions treated at Leicester Uveitis Service at Leicester Royal Infirmary and explore any proposed link.

Objectives: To assess if COVID19 vaccination is associated with uveitis flares in immunosuppressed patients.

Methods: A retrospective study, to determine if patients diagnosed with autoimmune conditions suffered from uveitis following COVID-19 vaccination. A data collection sheet was used to document demographic and clinical data: age, sex, ethnicity, autoimmune condition, dates of COVID-19 vaccination(s), type of vaccine, medication at the time of vaccine, symptoms of autoimmune recurrence, date of uveitis onset and number of days between uveitis onset and latest vaccine. We used an already existing uveitis database with an active register of 2346 patients, of which 246 were on immunomodulation.

Results: After reviewing the first 50 patients on immunosuppression for uveitis, we found a total of 4 patients had a uveitis flare despite tight control previously; 3 are female and 1 male, their median age was 39.5 years. They experienced a recurrence of uveitis in the last 6 months. Of these 4 patients 3 were on synthetic DMARDS (2 mycophenolate mofetil, 1 azathioprine), 1 was on steroids and 1 was on a biological DMARD (adalimumab). 2 of the patients suffered from posterior uveitis and 2 from anterior uveitis. All the 50 patients had been vaccinated against COVID19 however there was no clear record of booster dose.

Conclusion: Our study showed that of 50 immunosuppressed patients, 4 had a uveitis flare following vaccination. Clinicians need to be aware of uvetis flares in rheumatology patients following vaccination. This is a small retrospective analysis of our cohort however a large observational study on flare of uveitis following COVID-19 primary vaccination and booster vaccination would be useful to get meaningful data.

REFERENCES:

[1]Grunwald L, Newcomb CW, Daniel E, Kaçmaz RO, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Suhler EB, Thorne JE, Foster CS, Kempen JH; Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Risk of relapse in primary acute anterior uveitis. Ophthalmology. 2011 Oct;118(10):1911-5. doi: 10.1016/j.ophtha.2011.02.044. Epub 2011 Jun 16. PMID: 21680024; PMCID: PMC3179829.

[2]Bolletta E, Iannetta D, Mastrofilippo V, De Simone L, Gozzi F, Croci S, Bonacini M, Belloni L, Zerbini A, Adani C, Fontana L, Salvarani C, Cimino L. Uveitis and Other Ocular Complications Following COVID-19 Vaccination. J Clin Med. 2021 Dec 19;10(24):5960. doi: 10.3390/jcm10245960. PMID: 34945256; PMCID: PMC8704915.

Disclosure of Interests: None declared