{"doi":"10.1136/bjo-2025-328294","title":"Clade-specific ophthalmic manifestations of mpox: an umbrella review and meta-analysis of systematic reviews","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.","journal":"British Journal of Ophthalmology","year":2025,"id":549847,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8358,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1445199,"name":"Luxi Ji","orcid":null,"position":1,"is_corresponding":false},{"id":1445200,"name":"Olalekan A Uthman","orcid":null,"position":2,"is_corresponding":false},{"id":954610,"name":"Ed Mills","orcid":null,"position":3,"is_corresponding":false},{"id":85550,"name":"Alimuddin Zumla","orcid":"0000-0002-5111-5735","position":4,"is_corresponding":false},{"id":246875,"name":"Placide Mbala‐Kingebeni","orcid":"0000-0003-1556-3570","position":5,"is_corresponding":false},{"id":896846,"name":"Jean-Jacques Muyembe-Tamfum","orcid":null,"position":6,"is_corresponding":false},{"id":1444555,"name":"Elie Motulsky","orcid":"0000-0002-8708-4694","position":7,"is_corresponding":false},{"id":1445201,"name":"J Nachega","orcid":null,"position":8,"is_corresponding":false},{"id":261211,"name":"Oscar Kallay","orcid":null,"position":0,"is_corresponding":true}],"reference_count":23,"raw_metadata":null,"created_at":"2026-07-19T02:54:12.321988Z","pmid":"41469169","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}