Clinical characterization of Ebola-associated eye disease with spectral domain optical coherence tomography

Abstract

Purpose : Ebola Virus Disease (EVD) is associated with devastating ocular sequelae and vision loss among survivors. Detailed imaging is required to characterize the pathologial changes affecting vision. We describe a broad spectrum of intraocular pathology associated with EVD assessed by optical coherence tomography (OCT).

Methods : The PREVAIL III Ebola Survivor Study (sponsored by the US National Institute for Allergy and Infectious Disease and the Liberian Ministry of Health and Social Welfare) is a 5-year longitudinal study of the medical effects of EVD on survivors. Enrollment of 1500 survivors and up to 5000 controls is planned in Monrovia, Liberia. Spectral domain OCT imaging of the retina and optic nerve (Zeiss Cirrus, +/- Heidelberg Spectralis) was acquired from all participants during initial ophthalmic evaluation.

Results : Three hundred ninety Ebola survivors and 174 age-matched controls underwent comprehensive examination and imaging. Anterior segment OCT of survivors with active uveitis captured corneal edema, keratic precipitates, and shallowing of the anterior chamber associated with pupillary membrane formation. Macula OCT revealed overlying vitreous opacities in one or both eyes of 52% of survivors and 35% of controls (p=0.017). Macular pathology unique to survivors included a retinoschisis-type pattern of macular edema predominantly affecting the inner nuclear layer and multifocal chorioretinal lesions with focal loss of the outer retina. Tractional retinal detachment appeared in severe cases of panuveitis.

Conclusions : Spectral-domain OCT captures pathological changes that characterize EVD-associated eye disease and contribute to vision loss among survivors. Together with clinical examination, these findings expand the known spectrum of pathology associated with EVD. The data support the need for diagnostic and therapeutic capacity building in EVD-affected regions, and highlight the importance of not only short-term, but also long-term followup. Moreover, the findings reframe the approach to Ebola-associated eye disease as requiring both medical and surgical intervention.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.