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: < 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.