Madani Sedigheh
Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Med Hypothesis Discov Innov Ophthalmol. 2022 Apr 1;11(1):11-18. doi: 10.51329/mehdiophthal1440. eCollection 2022 Spring.
The coronavirus disease 2019 (COVID-19) pandemic has been the most challenging health problem in the last 2 years. Post-COVID-19 multisystem inflammatory syndrome of children (MIS-C) is a severe post-COVID-19 complication in pediatric patients. Ocular manifestations may be the first presentation of MIS-C, wherein prompt treatment may improve outcomes. In this systematic review, we aimed to summarize the acute and sub-acute ocular manifestations in pediatric patients with laboratory-confirmed COVID-19.
We included all online primary studies, with no language restriction and published between January 1, 2019 and November 18, 2020, reporting any acute or sub-acute ocular manifestations in children with laboratory-confirmed COVID-19. PubMed/MEDLINE was searched using the following MeSH and Emtree terms: "eye," "ophthalmologic," "ocular," "vision," "conjunctivitis," "severe acute respiratory syndrome coronavirus 2," "SARS-CoV-2," "corona," "2019-nCoV," "COVID19," and "COVID." The eligibility and quality of the selected records were assessed by two independent reviewers as per the Cochrane Handbook for Systematic Review.
A total of 1,192 records were identified electronically. Seven papers were extracted from the reference lists of the eligible records. Thirty-six papers met the inclusion criteria and were categorized into two subgroups according to acute or sub-acute presentation of ocular manifestations. Among 463 pediatric patients with COVID-19, 72 (15.5%) had acute ocular manifestations. There was one patient with central retinal vein occlusion and another with photophobia and diplopia associated with meningoencephalitis. Among 895 pediatric patients with post-COVID-19 MIS-C, 469 (52.4%) had ocular manifestations, which only included non-purulent conjunctivitis.
Ocular manifestations have been reported in less than one-fifth of pediatric patients with acute COVID-19. Furthermore, conjunctivitis was the only ocular manifestation reported in half of the patients with MIS-C, and it may be missed easily due to its non-purulent nature. During the COVID-19 pandemic, pediatricians and health workers must remain vigilant for early detection of signs of this potentially fatal post-COVID-19 inflammatory syndrome.
2019冠状病毒病（COVID-19）大流行是过去两年中最具挑战性的健康问题。儿童COVID-19后多系统炎症综合征（MIS-C）是儿科患者中一种严重的COVID-19后并发症。眼部表现可能是MIS-C的首发症状，及时治疗可能改善预后。在这项系统评价中，我们旨在总结实验室确诊的COVID-19儿科患者的急性和亚急性眼部表现。
我们纳入了所有在线的原始研究，无语言限制，发表时间为2019年1月1日至2020年11月18日，报告实验室确诊的COVID-19儿童的任何急性或亚急性眼部表现。使用以下医学主题词（MeSH）和Emtree术语在PubMed/MEDLINE中进行检索：“眼睛”、“眼科的”、“眼部的”、“视力”、“结膜炎”、“严重急性呼吸综合征冠状病毒2”、“SARS-CoV-2”、“冠状病毒”、“2019-nCoV”、“COVID-19”和“COVID”。根据Cochrane系统评价手册，由两名独立的评审员评估所选记录的合格性和质量。
通过电子检索共识别出1192条记录。从合格记录的参考文献列表中提取了7篇论文。36篇论文符合纳入标准，并根据眼部表现的急性或亚急性表现分为两个亚组。在463例COVID-19儿科患者中，72例（15.5%）有急性眼部表现。有1例中心视网膜静脉阻塞患者，另1例伴有脑膜脑炎的畏光和复视患者。在895例COVID-19后MIS-C儿科患者中，469例（52.4%）有眼部表现，仅包括非脓性结膜炎。
急性COVID-19儿科患者中报告有眼部表现的不到五分之一。此外，结膜炎是MIS-C患者中半数报告的唯一眼部表现，由于其非脓性性质，可能容易被漏诊。在COVID-19大流行期间，儿科医生和卫生工作者必须保持警惕，以便早期发现这种潜在致命的COVID-19后炎症综合征的迹象。
