Burden, timing, and outcomes of uveitis from a retrospective cohort of Ebola survivors in Sierra Leone

Abstract

Purpose : Uveitis has emerged as a sight-threatening sequelae of Ebola virus disease (EVD). We describe the prevalence of ocular diagnoses, severity of uveitis, and the timing of care and its association with clinical outcomes among EVD survivors after discharge from Ebola Treatment Units (or other treatment facility) in Sierra Leone.

Methods : We conducted a retrospective, programmatic cohort study using clinical records and program data from the Sierra Leone Ministry of Health and Sanitation National Eye Health Program EVD Survivors Screening and Treatment Campaign across 12 districts. Within the campaign, national ophthalmologists and mid-level ocular specialists provided care from March 2015 to March 2016. We used chi-squared tests to examine differences in clinical outcomes across groups.

Results : Of 2,667 patients (57% female), 62.6% (N=1,670) reported eye symptoms. Older patients were more likely to report eye symptoms (p<0.001). The prevalence of uveitis was 17.6% overall; and 14.7%,18% and 20% among survivors age <18, 18-40 and >40 years, respectively (p<0.05). Uveitis was more common in females than males (20% vs.15%; p=0.002), as were cataracts (12% vs. 6%; p<0.001). The median time from treatment facility discharge to first eye care visit was markedly delayed (290 days; IQR 182-360) compared with the median time to onset of eye symptoms (35; IQR 14-150). At the first visit, 19% of survivors with uveitis were blind in the worst affected eye (versus 2% without uveitis). By their most recent follow-up, 13% of patients with uveitis were blind, and 26.2% had cataracts compared to 5.4% without uveitis (p<0.001). Survivors who received uveitis treatment within 3 months of symptom onset experienced a significant improvement in visual acuity (60%) compared with those whose assessment and treatment was delayed (33%, p=0.002).

Conclusions : Nearly 1 in 5 EVD survivors developed uveitis and those that received early services were more likely to have improvement in visual acuity. Targeted interventions for survivors’ follow-up care were delayed during the outbreak, signaling a need to strengthen and plan for ocular services in future outbreaks to prevent disability. Our growing understanding of post-EVD long-term sequelae further signals a need to address the high burden of vision-threatening structural eye complications that persist beyond acute disease phase.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.