| کلیدواژههای انگلیسی مقاله |
COVID-19, SARS-CoV-2, Eye manifestations, Systematic review, Meta-analysis, What&,rsquo s Known Several prevalence estimates of ocular manifestations in COVID-19 patients have been reported. To date, pooled data analysis has not been carried out. What&,rsquo s New The pooled prevalence of ocular manifestations was about 24%, i.e., 24 in 100 patients had at least one ocular symptom. The most prevalent ocular symptoms in COVID-19 patients were dry eyes and conjunctival hyperemia. Pterygium and diplopia have been rarely reported. IntroductionIn late 2019, the first cases of coronavirus disease-2019 (COVID-19) were detected in Wuhan (China) and subsequently became a major global pandemic. 1, Within a year, more than 1.4 million deaths were reported worldwide. 2, The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is an enveloped beta coronavirus with positive-sense, single-stranded ribonucleic acid (RNA). 3, The primary route of SARS-CoV-2 transmission is through respiratory droplets and close contact, while other routes are being investigated. In comparison with other members of the coronavirus family (SARS-CoV and MERS-CoV), SARS-CoV-2 has multiple modes of transmission, a higher transmission rate, and is highly infectious. 4, . 5, Besides the polymerase chain reaction (PCR) test, other more sensitive and accurate methods have been proposed to detect the virus. 6, COVID-19 symptoms usually appear 2-14 days after exposure and may include fever, cough, fatigue, shortness of breath, headache, psychological distress, and gastrointestinal disorders. 7, , 8, Ocular complications caused by the SARS-CoV-2 virus have been reported in both humans and animals. Ocular symptoms in COVID-19 patients include conjunctivitis, anterior uveitis, retinitis, redness, and optic neuritis. 9, However, ocular infections due to the SARS-CoV-2 virus are less common than adenovirus or influenza viruses. The prevalence of ocular abnormalities in COVID-19 patients may range from 2% to 60%. 10, , 11, In a study on 103 clinically confirmed COVID-19 patients, 21% of the cases were reported to have ocular involvement. 9, Another study reported that 64.8% of COVID-19 patients had at least one ocular manifestation and the prevalence was associated with the severity of the disease. 10, In addition to the mouth and nose, coronavirus, can enter the body through the eyes. The presence of angiotensin-converting enzyme 2 (ACE2) on the cornea and conjunctival epithelium facilitates the entry of the virus into the host cell membrane. 12, A previous study reported the presence of SARS-CoV-2 RNA in tears and ocular fluids of COVID-19 patients. 13, Therefore, ocular route transmission should not be ignored and hand-eye contact should be avoided. Healthcare workers are thus required to wear eye protection, especially the ophthalmologists who may come into contact with tears or conjunctival secretions of COVID-19 patients. 14, However, the transmission of COVID-19 through ocular secretion is controversial and requires further research. 15, The present study aimed to identify ophthalmic symptoms of COVID-19 patients and establish an association between these symptoms and SARS-CoV-2 infection. Our findings complement the known symptoms of COVID-19 and contribute to appropriate and timely intervention in these patients. Materials and MethodsA systematic search of Medline, Scopus, Web of Science, Embase, and Cochrane Library was conducted for studies on the prevalence of SARS-CoV-2 related ocular manifestations. Without any language restrictions, publications from December 1st, 2019 to April 10th, 2021 were considered. To identify preprint papers, servers such as medRxiv and Social Science Research Network (SSRN) were also searched. The search strategy included a combination of medical subject headings (MeSH) terms and text words such as COVID-19, Coronavirus, SARS-CoV-2, Feature, Manifestation, Characteristic, Symptoms, Sign, Ocular, Eye, and Vision. The PICOTS (population, intervention, comparison, outcome, time, study design) components were COVID-19 patient, none, none, ocular manifestations/signs, none, and observational studies, respectively. Additionally, Google Scholar was searched to identify gray literature, and a virologist was consulted in the selection of important articles. The reference list of all articles was scanned manually to identify additional relevant studies. Identified citations were uploaded into Endnote X6 (Clarivate Analytics, United State) and duplicate citations were excluded. The remaining articles were initially screened for title relevancy, and then the abstract and full text were independently screened by two reviewers (R. P and S. S). Inter-rater disagreements were resolved after consultations with the third author (I. P). Blinding and a clear division of tasks were implemented in the article selection process. The inter-rater agreement was 92%. Inclusion criteria were all observational epidemiological studies (cohort, cross-sectional, and case series) on the prevalence of at least one ocular manifestation in patients with confirmed COVID-19. The exclusion criteria were case reports and case series with a sample size &,lt 5 and studies in the form of editorials, commentaries, letters to editors, and reviews. The assessment was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. 16, The quality of eligible studies was appraised independently by two of the authors (R. P and S. S) using the Newcastle-Ottawa Scale. 17, The scale consists of three parts, namely selection (four items), confounder (one item), and exposure (two items) with a maximum score of four, one, and two points, respectively. Based on the scoring system, studies were categorized as very good (6 or 7 points), good (4 or 5 points), satisfactory (2 or 3 points), and unsatisfactory (0 or 1 point). The extracted data from the selected studies were the name of authors, publication year, country, study design, sample size, the age and sex of COVID-19 patients, type of ocular manifestation, the prevalence of the most common ocular symptoms, and other ocular symptoms. Statistical Analysis Data were analyzed using Stata software, version 14.0 (StataCorp LLC, College Station, Texas, USA). Heterogeneity between the studies was examined using Cochran&,rsquo s Q test and the I2 index. Based on the Higgins classification approach, I2&,gt 0.7 was considered high heterogeneity. The pooled prevalence with a 95% confidence interval (CI) was calculated using the Stata command &,ldquo metaprop&,rdquo , and the pooled prevalence was estimated using the random-effects model. The meta-regression analysis was used to examine the effect of age and sample size on heterogeneity between the studies. The Stata command &,ldquo metabias&,rdquo was used to check publication bias. In case of any publication bias, the prevalence rate was adjusted with the Stata command &,ldquo metatrim&,rdquo using the trim-and-fill method. P values less than 5% were considered statistically significant. Ethics Approval and Consent to Participate This study was approved by the Ethics Committee of Ilam University of Medical Sciences (Ethical code, IR.MEDILAM.REC.1400.034).ResultsA total of 412 articles were retrieved from various databases, of which 99 duplicate studies were removed. The remaining 313 articles were screened for eligibility and 290 articles failed to meet one or more inclusion criteria. Eventually, 23 articles were selected in the systematic review (figure 1,). Of the 23 included articles, 9 (39.13%) were case series, 3 (13.04%) cohort, and 11 (47.83%) cross-sectional studies. The studies included a total of 3,650 COVID-19 patients aged one to 96 years with ocular manifestation (table 1,). The studies were primarily conducted in China (30.43%), Italy (13.04%), and Turkey (13.04%).Figure 1. The flow diagram depicts the selection process of studies in accordance with the PRISMA guidelines.AuthorCountryStudy designSample sizeAge (years) *,Ocular findingsTotalMaleFemaleManifestationPercentLee et al. 9, KoreaCase series10313.60%86.36%53&,plusmn 12Ocular symptoms21%Epiphora1.94%Itching sensation3.88%Visual disturbance5.82%Conjunctival congestion6.79%Ocular discomfort4.85%Ocular pain2.91%Liu et al. 17, ChinaCase series14250.70%49.30%48 (14-83)Ocular symptoms2.80%Ocular discomfort2.80%Sindhuja et al. 18, IndiaCase series12711.02%88.98%38.80 (5&,ndash 73)Ocular symptoms8.66%Conjunctival congestion6.30%Burning sensation0.79%Epiphora0.79%Swollen eyelid 0.79%Guemes-Villahoz et al. 19, SpainCase series30159.80%40.19%72 (59&,ndash 82)Ocular symptoms11.60%Conjunctivitis11.63%Foreign body sensation3.99%Subconjunctival hemorrhage0.99%Pterygium1.33%Hordeolum0.66%Epiphora4.98%Guemes-Villahoz et al. 20, SpainCase series3639%61%67.90 (28&,ndash 92)Ocular symptoms50%Conjunctivitis50%Subconjunctival hemorrhage8.33%Pterygium5.55%Conjunctival hyperemia50%Hordeolum2.78%Karimi et al. 21, IranCase series4367.50%32.50%56.60&,plusmn 13.70Ocular symptoms4.65%Conjunctivitis2.33%Foreign body sensation2.33%Atum et al. 15, TurkeyCase series4062.50%37.50%41.38&,plusmn 23.72 (1&,ndash 82)Ocular symptoms25%Conjunctivitis25 %Hong et al. 22, ChinaCross-sectional5655.40%44.60%48 (24&,ndash 68)Ocular symptoms27%Conjunctivitis3.57%Ocular pain5.36%Itching sensation5.36%Foreign body sensation7.14%Conjunctival hyperemia3.57%Dry eyes8.93%Eye secretions3.57%Zhang et al. 11, ChinaCross-sectional7250%50%58.68&,plusmn 14.81Ocular symptoms2.78%Conjunctivitis2.78%Rokohl et al. 23, GermanyCohort10847.22%52.78%37.90&,plusmn 13.70Ocular symptoms69.40%Burning sensations34.26%Itching sensations16.67%Epiphora31.48%Photophobia20.37%Foreign body sensations6.48%Conjunctivitis7.41%Swollen eyelid 13.89%Diplopia1.85%Conjunctival hyperemia24.07%Reduced visual acuity8.33%Ocular pain10.19%Cavalleri et al. 24, ItalyCross-sectional17268.03%31.97%64.2&,plusmn 13.4Ocular symptoms26.20%Conjunctival hyperemia15.12%Epiphora13.37%Eye secretion2.33%Swollen eyelid 2.91%Foreign body sensation9.89%Itching sensation6.98%Zhou et al. 14, ChinaCross-sectional12143.80%56.2%48 (22-89)Ocular symptoms6.60%Itching sensation4.13%Conjunctival hyperemia2.48%Epiphora2.48%Foreign body sensation1.65%Oncul et al. 25, TurkeyCross-sectional35954.90%45.10%58.50 (20-91)Ocular symptoms 4.50%Conjunctival hyperemia0.58%Epiphora1.39%Eye secretion1.67%Photophobia 1.11%Conjunctivitis 1.95%Chen et al. 26, ChinaCross-sectional53550.10%49.90%44.0 (34.0&,ndash 54.2)Ocular symptoms23.74%Dry eyes20.94%Conjunctival congestion4.67%Blurred vision 12.71%Foreign body sensation11.78%Eye secretion9.72%Ocular pain 4.11%Epiphora10.28%Itching sensation9.91%Valente et al. 27, ItalyCase series2774.10%25.90%7 (1-17.50)Ocular symptoms14.80%Conjunctivitis14.80%Bostanci et al. 28, TurkeyCross-sectional9358.10%41.90%39.40&,plusmn 21.90 (7-88)Ocular symptoms 21.50%Conjunctival hyperemia21.51%Epiphora 9.68%Eye secretion6.45%Conjunctivitis8.60%Photophobia 16.13%Itching sensation13.98%Burning sensation7.53%Foreign body sensation3.22%Blurred vision4.30%Abrishami et al. 10, IranCross-sectional14254.20%45.77%62.60&,plusmn 15 (23&,ndash 96)Ocular symptoms64.80%Conjunctival hyperemia30.98%Keratitis 2.11%Cataract7.75%Diabetic retinopathy6.34%Epiphora23.24%Hyperemia16.20%Eye irritation13.38%Itching sensation8.45%Foreign body sensation2.82%Ocular pain3.52%Photophobia0.70%Blurred vision0.70%Invernizzi et al. 29, ItalyCross-sectional5470.30%29.60%49.90&,plusmn 15.60 (23&,ndash 82)Ocular symptoms 27.70%Vision difficulties1.80%Hyperemia3.60%Burning sensation22.20%Photophobia1.80%Tostmann et al. 30, NetherlandsCross-sectional9021.10%78.90%39.01Ocular symptoms 34.40%Ocular pain34.40%Bourdon et al. 31, FranceCohort50060.60%39.40%40.60&,plusmn 20.30 (1-92)Ocular symptoms 64.20%Pterygium0.20%Diplopia1%Hordeolum21.80%Corneal abscess2%Recurrent corneal erosion1.20%Optic neuritis0.60%Macular disorder0.60%Angle-closure0.20%Vitreoretinal disorder11.80%Blepharitis9.20%Uveitis8.20%Conjunctivitis4.20%Foreign body sensation3.20%Subconjunctival hemorrhage 3%Xu et al. 32, ChinaCross-sectional1550%50%48&,plusmn 13.40Ocular symptoms6.67%Itching sensation6.67%Lan et al. 33, ChinaCase series8140.70%59.30%41.69&,plusmn 18.60Ocular symptoms 3.70%Itching sensation3.70%Swollen eyelid 2.47%Dry eyes1.24%Conjunctivitis2.47%Perlman et al. 34, USACohort43362.40%37.60%37.50&,plusmn 13.80Ocular symptoms29.10%Dry eyes29.10%Ocular pain19.17%*Data presented as mean (range), mean&,plusmn SD (range), or mean |
| نویسندگان مقاله |
Saber Soltani |
Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Milad Zandi |
Department of Hematology and Blood Banking, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
Seyed-Esmaeil Ahmadi |
Department of Hematology and Blood Banking, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
Bahman Zarandi |
Department of Hematology and Blood Banking, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
Zeinab Hosseini |
Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
Sara Akhavan Rezayat |
Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Morteza Abyadeh |
Cell Science Research Center, Department of Molecular Systems Biology, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
Iraj Pakzad |
Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
Pooneh Malekifar |
Department of Epidemiology, School of Public Health, Tehran University Medical Sciences, Tehran, Iran
Reza Pakzad |
Department of Epidemiology, Faculty of Health, Ilam University Medical Sciences, Ilam, Iran
Sayed-Hamidreza Mozhgani |
Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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