The characteristics of white dot syndromes following COVID-19 Vaccines: a systematic review.

PURPOSE: To review all studies reporting the onset of white dot syndromes following COVID-19 vaccines. METHODS: Our protocol was registered prospectively on PROSPERO [registration number: CRD42023426012]. We searched five different databases including PubMed, Scopus, Web of Science, Google Scholar, and Science Direct up to May 2023. All the studies that reported the occurrence of white dot syndrome following COVID-19 vaccines were included. All statistical tests were conducted with a 95% confidence interval and a 5% error margin. A p value of less than 0.05 was considered statistically significant. The methodological quality of included studies was performed using the IHE Quality Appraisal Checklist for Case Series studies and JBI Critical Appraisal Checklist for Case Reports. RESULTS: Fifty studies involving seventy-one subjects were included. Multiple evanescent white dot syndrome (MEWDS) was the most common disease (n = 25, 35.2% %), followed by acute macular neuroretinopathy (AMN) (n = 22, 31.0%) and acute posterior multifocal placoid pigment epitheliopathy (APMPPE) (n = 4, 5.6%). They were mostly unilateral (n = 50, 70.4%). The presenting symptoms were blurred vision (n = 26, 36.6%), paracentral scotoma (n = 19, 26.8%), visual field disturbance, and photopsia (n = 7, 9.9%). The mean duration for follow-up was 10.15 ± 14.04 weeks. Nineteen subjects (29.69%) received steroids with improvement reported in 68.4%. Eleven subjects (17.19%) were managed by observation only with reported full recovery and improvement. CONCLUSION: White dot syndromes are very rare entities. Our findings highlight a possible association between COVID-19 vaccines and the occurrence of white dot syndromes. However, larger studies with good quality should be implemented to confirm these findings.

Endovascular Thrombectomy for Acute Stroke with a Large Ischemic Core: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Endovascular thrombectomy (ET) efficacy and safety in stroke with a large ischemic core is still inconclusive as this population has been underrepresented in ET randomized controlled trials (RCTs). METHODS: We conducted a systematic review and meta-analysis synthesizing RCTs, which were retrieved by systematically searching: PubMed, Web of Science, SCOPUS, and Cochrane through February 18th, 2023. Our primary outcome was neurological disability measured by the modified Rankin scale (mRS). Dichotomous outcomes were pooled using risk ratio (RR) along with confidence interval (CI) using Revman V. 5.4 software. RESULTS: Three RCTs with a total of 1010 patients were included in our analysis. ET significantly increased the rates of functional independence (mRS ≤ 2) (RR: 2.54 with 95% CI [1.85, 3.48]), independent ambulation (mRS ≤ 3) (RR: 1.78 with 95% CI [1.28, 2.48]), and early neurological improvement (RR: 2.46 with 95% CI [1.60, 3.79]). However, there was no difference between endovascular thrombectomy and medical care in excellent neurological recovery (mRS ≤ 1) (RR: 1.35 with 95% CI [0.88, 2.08]). Also, ET significantly reduced the rate of poor neurological recovery (mRS 4-6) (RR: 0.79 with 95% CI [0.72, 0.86]). However, endovascular thrombectomy was associated with more incidence of any intracranial hemorrhage (RR: 2.40 with 95% CI [1.90, 3.01] [0.72, 0.86]). CONCLUSION: ET combined with medical care was associated with better functional outcomes compared with medical care alone. However, ET was associated with a higher rate of intracranial hemorrhage. This can support extending ET indication in the management of stroke with a large ischemic core.