Vogt-Koyanagi-Harada in the era of COVID-19 infection and vaccination: a systematic review and analysis of current evidence

Purpose Review is synthesized and analyze the current available evidence on the onset of Vogt-Koyanagi-Harada (VKH) disease related with both SARS-CoV-2 infection and COVID-19 vaccination.Materials and methods The literature search was undertaken in PubMed, Scopus, EMBASE and Web of Science. The Joanna Briggs Institute tool (JBI) and Newcastle-Ottawa Score (NOS) were used to assess the risk of bias and quality of the studies.Results Twenty-one case reports were included, with a total of 116 patients. Of these, 66 developed new-onset VKH as a complication of SARS-CoV-2 infection, while 14 relapsed. As for the cases associated with COVID-19 vaccination, 31 corresponded to new VKH diagnoses. The most frequent clinical manifestations in the infection subgroup were blurred vision, tinnitus, and ocular pain, whereas in the vaccination subgroup, blurred vision, vision loss, and metamorphopsia predominated. A higher frequency of adverse events was observed with mRNA-based vaccines, particularly Pfizer-BioNTech (48.4%). Most cases occurred after the first dose (51.6%), with a higher prevalence in females and a predominance of bilateral ocular involvement in both groups.Conclusions Cases of VKH disease have been reported in related with both SARS-CoV-2 infection and COVID-19 vaccination. However, the available evidence is limited to temporal associations, which do not allow for the establishment of a causal relationship.Systematic review registration PROSPERO CRD42024522472.