Chew Milton C, Wiryasaputra Shaan, Wu Meihui, Khor Wei Boon, Chan Anita S Y
Singapore National Eye Centre, Singapore, Singapore.
Translational Ophthalmic Pathology Platform, Singapore Eye Research Institute, Singapore, Singapore.
Front Med (Lausanne). 2022 Jun 22;9:925683. doi: 10.3389/fmed.2022.925683. eCollection 2022.
We report vaccine and booster-related uveitis in Singapore, a country with high vaccination and booster rates to highlight the differences and potential role of prophylactic treatment for sight-threatening infectious uveitis.
Clinical data extracted from the de-identified uveitis database in Singapore National Eye Center. Six patients (eight eyes) developed uveitis within 14 days after undergoing COVID-19 vaccination (primary and/or booster).
All patients received two doses of COVID-19 vaccination, and 1.39% (6/431) developed COVID-19 vaccine-related uveitis. Fifty-percent% (3/6) with non-infectious anterior uveitis (NIAU) presented with a non-granulomatous anterior uveitis (AU). The remaining (3/6) presenting with a granulomatous AU were diagnosed with reactivation of cytomegalovirus, varicella-zoster virus and toxoplasma chorioretinitis, respectively. All the patients responded to definitive treatment specific to their diagnosis. The mean visual acuity at presentation was 0.36 ± 0.20 logMAR and improved to 0.75 ± 0.09 ( = 0.009). Mean time from vaccination to uveitis was 9.7 (range: 3-14) days. All patients developed uveitis after second vaccination dose. 16.67% (1/6) patients had a recurrence after the third booster dose. None of the three patients with infectious uveitis developed recurrence but had received maintenance therapy up to or during the booster.
Uveitis after COVID-19 vaccination is uncommon. In our series, a higher rate of reactivations of latent infections was seen. With definitive treatment, all cases were self-limited without systemic sequelae. Prophylactic treatment during booster vaccine may prevent reactivation of sight-threatening infections and reduce morbidity although risk-benefits should be considered for individual patients given the low rate of occurrence.
我们报告了新加坡的疫苗及加强针相关葡萄膜炎情况。新加坡的疫苗接种率和加强针接种率很高，我们旨在强调预防性治疗对于威胁视力的感染性葡萄膜炎的差异及潜在作用。
从新加坡国家眼科中心的匿名葡萄膜炎数据库中提取临床数据。6名患者（8只眼）在接种新冠疫苗（首剂和/或加强针）后14天内发生了葡萄膜炎。
所有患者均接种了两剂新冠疫苗，1.39%（6/431）发生了新冠疫苗相关葡萄膜炎。50%（3/6）的非感染性前葡萄膜炎（NIAU）患者表现为非肉芽肿性前葡萄膜炎（AU）。其余（3/6）表现为肉芽肿性AU的患者分别被诊断为巨细胞病毒、水痘带状疱疹病毒和弓形虫脉络膜视网膜炎复发。所有患者对针对其诊断的明确治疗均有反应。就诊时的平均视力为0.36±0.20 logMAR，改善至0.75±0.09（P = 0.009）。从接种疫苗到发生葡萄膜炎的平均时间为9.7天（范围：3 - 14天）。所有患者均在接种第二剂疫苗后发生葡萄膜炎。16.67%（1/6）的患者在接种第三剂加强针后复发。3例感染性葡萄膜炎患者均未复发，但在加强针接种时或接种期间接受了维持治疗。
新冠疫苗接种后发生葡萄膜炎并不常见。在我们的系列研究中，潜伏感染的复发率较高。经过明确治疗，所有病例均为自限性，无全身后遗症。加强针疫苗接种期间的预防性治疗可能预防威胁视力的感染复发并降低发病率，不过鉴于发生率较低，对于个体患者应考虑风险效益。
