Ophthalmic Manifestations and Causes of Vision Impairment in Ebola Virus Disease Survivors in Monrovia, Liberia

Shantha, Jessica G.; Crozier, Ian; Hayek, Brent; Bruce, Bonnie; Gargu, Catherine; Brown, Jerry; Fankhauser, John; Yeh, Steven

doi:10.1016/j.ophtha.2016.10.011

Cited by 59 publications

(94 citation statements)

References 12 publications

(17 reference statements)

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“…Unilateral presentations were observed more commonly than bilateral disease. Vision was worse than 20/400 in 39% of affected eyes in this series from Liberia, underscoring potential for blinding complications that require urgent attention by the medical community [13 ■■ ,14,15 ■■ ,16,18,19]. …”

Section: Post Ebola Virus Disease Syndromementioning

confidence: 99%

“…Uveitis has specifically been identified as the most common ophthalmic manifestation and is observed in 13–34% of EVD survivors [13 ■■ ,14,15 ■■ ,16]. Table 1 summarizes the recent retrospective and prospective series describing ophthalmic manifestations in EVD survivors.…”

Section: Post Ebola Virus Disease Syndromementioning

confidence: 99%

“…Other EVD-associated ocular complications include neuro-ophthalmic disease including optic neuropathy and ocular motility disorders [13 ■■ ]. …”

Section: Post Ebola Virus Disease Syndromementioning

confidence: 99%

“…Specifically, while both of the United States health care workers recovered vision following therapy [17 ■ ,21], nearly 40% of eyes in the Liberian cohort had vision worse than 20/400 had their initial presentation, sometimes because of structural complications including cataract and dense vitreous opacity [13 ■■ ]. …”

Section: Post Ebola Virus Disease Syndromementioning

confidence: 99%

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An update on ocular complications of Ebola virus disease

Shantha

Crozier

Yeh

2017

Current Opinion in Ophthalmology

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Purpose of review This review provides a summary of our current understanding of the ophthalmic manifestations of Ebola virus disease (EVD), pathogenesis, treatment options and directions for future study. The individual, public health and global health implications of eye disease in EVD survivors are discussed. Recent findings The West Africa EVD outbreak was of unprecedented magnitude, leading to the largest survivor cohort since the first documented EVD outbreak in 1976. Because of the magnitude of the recent outbreak, thousands of survivors are at-risk of systemic and ophthalmic sequelae termed the ‘post Ebola virus disease syndrome’. Uveitis is the most common finding during EVD convalescence and may lead to severe vision impairment or blindness in 40% of affected individuals. Ocular complications leading to vision loss include cataract, retinal scarring, optic neuropathy, hypotony and phthisis bulbi. The pathogenesis of eye disease in EVD survivors likely involves Ebola virus persistence, severe inflammation and tissue edema, which present as acute, rapidly progressive disease or chronic, smoldering disease. Further studies into disease pathogenesis including mechanisms of viral persistence may provide guidance into therapies for uveitis secondary to EVD. Summary Uveitis is the most common ophthalmic finding in EVD survivors and can lead to vision loss. Further studies into the clinical manifestations and mechanisms of disease are needed to improve therapies for EVD survivors who often have limited access to ophthalmic medical and surgical care.

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Section: Post Ebola Virus Disease Syndromementioning

confidence: 99%

Section: Post Ebola Virus Disease Syndromementioning

confidence: 99%

“…Other EVD-associated ocular complications include neuro-ophthalmic disease including optic neuropathy and ocular motility disorders [13 ■■ ]. …”

Section: Post Ebola Virus Disease Syndromementioning

confidence: 99%

Section: Post Ebola Virus Disease Syndromementioning

confidence: 99%

See 2 more Smart Citations

An update on ocular complications of Ebola virus disease

Shantha

Crozier

Yeh

2017

Current Opinion in Ophthalmology

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“…Interestingly, optic neuropathy without uveitis was also reported. [57][58][59][60] Uncertain Viral Anterior Uveitis Entities Epstein-Barr virus-associated anterior uveitis Epstein-Barr-virus (EBV) is also a member of the herpes virus family. It has repeatedly been reported as a cause of diverse types of uveitis, but the role of EBV in uveitis is not entirely clear, since PCR in aqueous fluid can be positive in EBV-infected patients without uveitis.…”

Section: 53mentioning

confidence: 99%

Challenges of Diagnosing Viral Anterior Uveitis

Groen-Hakan

Babu²,

Tuğal-Tutkun

et al. 2017

Ocular Immunology and Inflammation

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The viral causes of anterior uveitis (AU) emerged with the use of novel molecular diagnostic tests and serologic tests adapted for small volumes (Goldmann-Witmer Coefficient). The viral causes of AU may be underestimated, and some of the presumed idiopathic AU cases will probably be proven to be of viral origin in the coming years. So far, a viral origin of AU was suspected in patients who presented with unilateral hypertensive AU. It is not clear which clinical presentations should raise a suspicion of viral etiology. There is an overlap in the clinical manifestations of AU caused by viruses and other non-viral forms of AU. A viral cause of AU should be suspected in patients with unilateral AU, exhibiting small or medium sized KPs, some form of iris atrophy, high IOP and early development of a cataract and the definitive diagnosis can be proven by aqueous humor analysis.

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Characterization of Ebola Virus–Associated Eye Disease

Eghrari¹,

Bishop

Ross

et al. 2021

JAMA Netw Open

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IMPORTANCESurvivors of Ebola virus disease (EVD) may experience ocular sequelae. Comparison with antibody-negative individuals from the local population is required to characterize the disease. OBJECTIVE To assess features of ophthalmic disease specific to EVD. DESIGN, SETTING, AND PARTICIPANTS This baseline cross-sectional analysis of survivors of EVD and their close contacts was conducted within PREVAIL III, a 5-year, longitudinal cohort study. Participants who enrolled at John F. Kennedy Medical Center in Liberia, West Africa from June 2015 to March 2016 were included in this analysis. Close contacts were defined as household members or sex partners of survivors of EVD. Data were analyzed from July 2016 to July 2020. EXPOSURES All participants, both survivors and close contacts, underwent testing of IgG antibody levels against Ebola virus surface glycoprotein. MAIN OUTCOMES AND MEASURES Ocular symptoms, anterior and posterior ophthalmologic examination findings, and optical coherence tomography images were compared between antibodypositive survivors and antibody-negative close contacts. RESULTS A total of 564 antibody-positive survivors (320 [56.7%] female; mean [SD] age, 30.3 [14.0] years) and 635 antibody-negative close contacts (347 [54.6%] female; mean [SD] age, 25.8[15.5] years) were enrolled in this study. Survivors were more likely to demonstrate color vision deficit (28.9% vs 19.0%, odds ratio [OR], 1.6; 95% CI, 1.2-2.1) and lower intraocular pressure (12.4 vs 13.5 mm Hg; mean difference, −1.2 mm Hg; 95% CI, −1.6 to −0.8 mm Hg) compared with close contacts. Dilated fundus examination revealed a higher percentage of vitreous cells (7.8% vs 0.5%; OR, 16.6; 95% CI, 5.0-55.2) and macular scars (4.6% vs 1.6%; OR, 2.8; 95% CI, 1.4-5.5) in survivors than in close contacts. Uveitis was present in 26.4% of survivors and 12.1% of close contacts (OR, 2.4; 95% CI, 1.8-3.2). Among all participants with uveitis, survivors were more likely than close contacts to have intermediate uveitis (34.2% vs 6.5% of all cases; OR, 7.8; 95% CI, 3.1-19.7) and had thicker mean central subfield thickness on optical coherence tomography (222 vs 212 μm; mean difference, 14.4 μm; 95% CI, 1.9-26.9 μm). CONCLUSIONS AND RELEVANCEIn this cross-sectional study, survivors of EVD had a distinct spectrum of ocular and neuro-ophthalmologic findings compared with close contacts that potentially require medical and surgical treatment.

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Ophthalmic Manifestations and Causes of Vision Impairment in Ebola Virus Disease Survivors in Monrovia, Liberia

Cited by 59 publications

References 12 publications

An update on ocular complications of Ebola virus disease

An update on ocular complications of Ebola virus disease

Challenges of Diagnosing Viral Anterior Uveitis

Characterization of Ebola Virus–Associated Eye Disease

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