Clade-specific ophthalmic manifestations of mpox: an umbrella review and meta-analysis of systematic reviews
Bibliographic record
Abstract
BACKGROUND: On 14 August 2024, the WHO redesignated Monkeypox (mpox) as a Public Health Emergency of International Concern. Ocular disease is under-recognised and can cause irreversible vision loss. Clarifying its burden, clade-specific patterns and HIV-related risks is essential for clinical care and public health. METHODS: We conducted an umbrella review and meta-analysis, systematically searching PubMed, Embase, Scopus, Web of Science and the Cochrane Library from inception to September 2025. Eligible studies were systematic reviews reporting ophthalmic manifestations in laboratory-confirmed mpox cases, stratified by viral clades I, II and IIb. Pooled proportions were estimated using random-effects meta-analysis, with clade-stratified subgroup analyses. The protocol was registered in PROSPERO (CRD420251137180). RESULTS: Five systematic reviews (36 primary studies; 28 139 patients) were included. The pooled proportion of conjunctivitis was 8.9% (95% CI 4.8 to 13.9), highest in clade I (21.9%) and lowest in clade IIb (2.7%). Keratitis (1.5%), eyelid lesions (3.3%), conjunctival lesions (8.4%) and corneal ulceration (3.3%) varied by clade. Visual impairment occurred in 4.5% overall; unilateral (0.9%) and bilateral (0.4%) blindness were reported only with clade I. Across reviews, people living with advanced HIV experienced disproportionately higher rates of severe and persistent ocular complications than HIV-negative individuals. CONCLUSIONS: Mpox-related ophthalmic disease can cause substantial-and potentially preventable-visual disability. Clade I infection is associated with a greater burden of ocular complications than clade II-particularly IIb. Improved access to eye health services, early recognition and integration of HIV and mpox care are critical to reducing vision loss, especially in resource-limited settings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.062 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.034 |
| Bibliometrics | 0.015 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".