June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Longitudinal Changes of Geographic Retinal Darkening in a Cohort of Ebola Survivors
Author Affiliations & Notes
  • Paul J Steptoe
    Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
  • Nicholas V Beare
    Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, Merseyside, United Kingdom
    St.Paul's Eye Department, Royal Liverpool Hospital, Liverpool, Merseyside, United Kingdom
  • Janet T Scott
    Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
  • Matthew Jusu Vandy
    Ophthalmology Department, Connaught Hospital, Freetown, Sierra Leone
  • Lloyd Harrison-Williams
    Ophthalmology Department, Connaught Hospital, Freetown, Sierra Leone
  • Fayiah Momorie
    Department of Ophthalmology, 34th Regiment Military Hospital, Republic of Sierra Leone Armed Forces Joint Medical Unit, Freetown, Sierra Leone
  • Alimamy D Fornah
    Department of Ophthalmology, 34th Regiment Military Hospital, Republic of Sierra Leone Armed Forces Joint Medical Unit, Freetown, Sierra Leone
  • Julia M Baxter
    St.Paul's Eye Department, Royal Liverpool Hospital, Liverpool, Merseyside, United Kingdom
  • Craig K Parkes
    St.Paul's Eye Department, Royal Liverpool Hospital, Liverpool, Merseyside, United Kingdom
  • Rahul Dwivedi
    St.Paul's Eye Department, Royal Liverpool Hospital, Liverpool, Merseyside, United Kingdom
  • Foday Sahr
    Department of Ophthalmology, 34th Regiment Military Hospital, Republic of Sierra Leone Armed Forces Joint Medical Unit, Freetown, Sierra Leone
  • Simon P Harding
    Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, Merseyside, United Kingdom
  • Malcolm G Semple
    Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
  • Footnotes
    Commercial Relationships   Paul Steptoe, Bayer (F), The Dowager Countess Eleanor Peel Trust (F); Nicholas Beare, None; Janet Scott, Wellcome Trust (F); Matthew Vandy, None; Lloyd Harrison-Williams, None; Fayiah Momorie, None; Alimamy Fornah, None; Julia Baxter, None; Craig Parkes, None; Rahul Dwivedi, None; Foday Sahr, None; Simon Harding, None; Malcolm Semple, Wellcome Trust (F)
  • Footnotes
    Support  Bayer Global Ophthalmology Awards Programme Grant
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2991. doi:
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      Paul J Steptoe, Nicholas V Beare, Janet T Scott, Matthew Jusu Vandy, Lloyd Harrison-Williams, Fayiah Momorie, Alimamy D Fornah, Julia M Baxter, Craig K Parkes, Rahul Dwivedi, Foday Sahr, Simon P Harding, Malcolm G Semple; Longitudinal Changes of Geographic Retinal Darkening in a Cohort of Ebola Survivors. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2991.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Little is known regarding the longitudinal retinal sequelae in Ebola virus disease (EVD) survivors. An Ebola-specific retinal lesion and associated areas of geographic retinal darkening (GRD) were observed amongst EVD survivors in a previous case-control study. GRD, also known as dark-without-pressure are little understood but lesional OCT correlates to retinal ellipsoid layer hyporeflectivity. We performed an observational study in a cohort of EVD survivors to observe for longitudinal changes.

Methods : 137 Ebola survivors were invited for ophthalmic examination including widefield retinal imaging (Optos® Daytona, Dunfermline, UK) in Freetown, Sierra Leone. Median age was 31 (IQR 23.5-39). M:F ratio::1:0.78. Median time from Ebola treatment unit discharge to ophthalmic review was 479 days (range 97-977 days). Patients with identified GRD and/or Ebola retinal lesions were invited for examinations between January and November 2016.

Results : 95 presumed Ebola-specific retinal lesions were identified in 12.4% (17/137) of survivors. Mean number of lesions per eye was 3.9 (range 1-24, SD 5.19). All were systemically well and visually asymptomatic. 84.2% of these had a circumferential dark retinal halo. 18.8% (12/137) of survivors had areas of GRD (33.3% bilateral). Four patterns were identified (Figure 1): a) mid-peripheral (MP) (N=5), b) circumferential inline with the retinal arcade (CA) (N=3), c) distinct peripheral margin with circumferential posterior pole border (N=4), d) distinct peripheral margin with no posterior pole border (N=5). Mean period of review was 210 days (range 62-290, SD 77.3). All MP GRD areas showed recession over time, one of which developed perivascular infiltrates which resolved without treatment. All CA areas showed evidence of expansion. 66.7% had co-existent white-without-pressure.

Conclusions : We provide the first evidence of GRD in EVD survivors and propose a classification scheme based on imaging appearance. We found examples of GRD expanding and receding over time. The ellipsoid layer anatomically correlates to a high density of retinal mitochondria. Changes in mitochondrial refractivity have been shown to equate to enzymatic activity. Hypo-reflectivity of this layer, seen in GRD may therefore indicate visualisation of a viral effect upon retinal mitochondrial metabolic state. These findings may have systemic parallels in relation to Post-Ebola syndrome.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

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