Period prevalence of ocular inflammation and corneal allograft rejection within 30 days of COVID-19 vaccination

Purpose To determine the period prevalence of new or recurrent ocular inflammation, including corneal allograft rejection, occurring within 30 days after COVID-19 vaccination. Methods This retrospective cohort study was conducted at a tertiary referral eye center. A systematic random sample of 4,638 patient charts (50% of eligible charts after removal of duplicate encounters identified by relevant ICD-10 codes) from December 1, 2020, to April 9, 2023, was reviewed using a computer-generated random start and a fixed sampling interval of 2. Patients were included if they developed new or recurrent ocular inflammation within 30 days of COVID-19 vaccination. Main outcome measures included the period prevalence of post-vaccination ocular inflammation, the proportion with new-onset inflammation, the proportion with recurrent inflammation among patients with prior inflammatory disease, and the frequency of corneal allograft rejection. Results Among the 4,638 sampled patients with ocular inflammation-related ICD-10 codes, 77 met inclusion criteria, representing a period prevalence of 1.66% within 30 days of COVID-19 vaccination. The mean age was 58.0 years and 58.4% were male. Diagnoses included uveitis ( n = 38), herpetic keratitis ( n = 32), birdshot choroidopathy ( n = 2), chorioretinitis ( n = 2), pars planitis ( n = 1), Staphylococcus-associated marginal keratitis ( n = 1), and corneal allograft rejection ( n = 1). Among patients with prior ocular inflammation, 0.65% experienced a recurrent event within 30 days of vaccination; among those without prior history, 1.01% had newly documented inflammation in the same window. The single episode of corneal allograft rejection occurred 13 days after the second dose of the Pfizer-BioNTech vaccine in a patient with prior Descemet stripping endothelial keratoplasty for Fuchs corneal dystrophy. Most cases responded to corticosteroid or antiviral therapy. Conclusion Ocular inflammation within 30 days of COVID-19 vaccination was uncommon, and corneal allograft rejection was exceptionally rare in this large tertiary-center cohort. These findings support the continued use of COVID-19 vaccination in patients with prior ocular inflammatory disease or corneal transplantation, with appropriate post-vaccination monitoring.