Ocular Safety of Recombinant Zoster Vaccination in Adults Aged 50 Years and Older: A Propensity-Matched Real-World Cohort Study.

PURPOSE: To evaluate the risk of ophthalmic adverse events following recombinant zoster vaccination (Shingrix) in adults aged 50 and older.

METHODS

This retrospective cohort study used the TriNetX Research Network to compare Shingrix recipients with unvaccinated adults aged 50 years and older who had at least two medical examination encounters on or after January 1, 2017. Shingrix recipients and unvaccinated controls were matched 1:1 using nearest-neighbor propensity score matching for demographics, comorbidities, and healthcare utilization. Outcomes of interest included one-year incidence of zoster eye disease, keratitis, conjunctivitis, iridocyclitis, scleritis, optic neuritis, retinal vascular occlusion, and ophthalmology follow-up. Risk ratios and Cox proportional hazards models with log-rank testing were used to estimate effect sizes. Secondary analyses examined ocular outcomes among Shingrix recipients stratified by non-ocular zoster history.

RESULTS

After matching, 837,362 patients remained in each cohort with well-balanced baseline characteristics. Shingrix recipients had higher ophthalmology follow-up than controls (5.65% vs 4.51%; HR 1.27, 95% CI 1.25-1.29; p < 0.0001). Zoster eye disease was less frequent after Shingrix vaccination (HR 0.82, 95% CI 0.70-0.97; p = 0.02), as was keratitis (HR 0.73, 95% CI 0.69-0.78; p < 0.0001). Iridocyclitis, scleritis, optic neuritis, and retinal vascular occlusion were rare and not significantly increased. Prior non-ocular zoster was associated with higher rates of ophthalmology follow-up, keratitis, conjunctivitis, and optic neuritis.

CONCLUSIONS

Shingrix vaccination was not associated with increased serious ophthalmic adverse events and was associated with lower rates of zoster eye disease and keratitis. Prior non-ocular zoster history may identify patients with greater baseline susceptibility to ocular diagnoses.