Anterior Uveitis Associated with ASIA Syndrome: A Distinct Clinical Entity?

To investigate whether anterior uveitis developing after BNT162b2 COVID-19 vaccination-classified as Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA)-exhibits distinct clinical features compared to idiopathic uveitis.

This single-center retrospective study analyzed records of patients diagnosed with non-infectious anterior uveitis between June 1, 2021, and December 31, 2022. Patients were categorized into two groups: post-vaccine ASIA-related uveitis (Group 1) and idiopathic uveitis (Group 2).

A total of 62 patients were included: 12 in Group 1 and 50 in Group 2. The mean age was similar (33.8 ± 10.4 vs. 35.1 ± 10.8 years; p = 0.547), with male predominance in both groups (61.1% vs. 58.5%). Group 1 had significantly milder anterior chamber inflammation (1.94 ± 0.64 vs. 2.85 ± 0.94; p < 0.001) and fewer ocular complications (16.7% vs. 60.0%; p = 0.003). All Group 1 cases responded to topical corticosteroids alone, while 32.3% in Group 2 required systemic immunosuppressants (p = 0.004). Best corrected visual acuity improved in both groups over time, but recovery was faster and more complete in Group 1 (p < 0.001 for time × group interaction).

Anterior uveitis associated with ASIA syndrome post-vaccination appears to follow a milder, self-limiting course, with better visual outcomes and less aggressive treatment needs than idiopathic uveitis. These findings offer important insight into the clinical behavior of vaccine-associated ocular inflammation.