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John Mattia, Matthew Vandy, Devin Platt, Kerry Dierberg, Ruxandra Pinto, Yealie Mansaray, Amadu Kamara, Ian Crozier, Jessica Shantha, Steven Yeh, Joyce Chang; Factors associated with vision impairment in Ebola virus disease uveitis in Sierra Leone. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4509.
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© ARVO (1962-2015); The Authors (2016-present)
There are over 15,000 Ebola virus disease (EVD) survivors in West Africa, of whom an estimated 15-20% develop uveitis after their acute EVD infection. We sought to describe clinical and ocular factors associated with vision impairment in EVD survivors with uveitis.
We performed a retrospective review of 50 EVD survivors with uveitis from a clinical cohort of 277 EVD survivors in Sierra Leone. We examined the univariate association between demographic characteristics (per patient), serum Ebola viral load at time of acute EVD diagnosis (per patient), and ocular structural complications (per eye) with visual impairment. Visual acuity outcomes included the logMAR of visual acuity, and separately, a categorical classification of vision impairment: normal/mild (20/20-20/25); moderate (20/30-20/160); severe (20/200-20/400); blindness (20/400 or worse). Per-patient analyses are reported for the eye with the worst visual acuity.
Uveitis was diagnosed in 68 eyes (46% anterior, 26% posterior, 3% intermediate uveitis, and 25% panuveitis), and was unilateral in 64% of patients. Uveitis patients developed ocular symptoms a median of 3 weeks (IQR, 0.4-8.6 weeks; range, 0-17.2 weeks) after discharge from Ebola treatment centres. Of the 62 eyes with visual acuity data, there was no significant difference in logMAR visual acuity between males and females (p=0.21). There was no significant correlation between logMAR visual acuity with age (p=0.9), Ebola viral load at acute EVD diagnosis (p=0.24), nor duration of symptoms prior to ophthalmologic assessment (p=0.07). Severe vision impairment and blindness were observed in at least one eye in 19 of 62 eyes (30.1%). Structural complications were each associated with worse visual acuity (Table 1): cataracts, posterior synechiae, and vitreous opacity.
Uveitis may result in severe vision impairment or blindness in a third of eyes among EVD survivors. Structural complications contribute to vision impairment in post-EVD uveitis. Although further study in a larger number of patients is required to characterize independent predictors of visual impairment in post-EVD uveitis, urgent ocular resources should be directed towards the diagnosis and care of this sight-threatening post-EVD complication across West Africa.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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