Long-term decrease in intraocular pressure in survivors of Ebola virus disease in the PREVAIL III Study

Abstract

Purpose : Survivors of Ebola virus disease (EVD) experience decreased intraocular pressure (IOP) relative to unaffected close contacts during the first year of convalescence. Whether this effect persists over time, and its relationship to intraocular pathology, is unclear. We sought to determine if IOP remained lower in survivors of EVD over four years of follow-up, and to identify associated risk factors.

Methods : PREVAIL III is a 5-year, longitudinal cohort study of survivors of EVD and their close contacts and is a collaboration between the Liberian Ministry of Health and the United States National Institutes of Health. Participants who enrolled in PREVAIL III at John F. Kennedy Medical Center in Liberia, West Africa from June 2015 to March 2016 underwent comprehensive ophthalmic evaluation annually for 5 consecutive visits. IOP was measured at each visit by a handheld rebound tonometer using sterile tips. Comparisons are made between antibody-positive survivors and antibody-negative close contacts. Among survivors, we tested for associations between IOP and findings on physical examination, optical coherence tomography, or diagnosis of uveitis at baseline.

Results : Of 565 antibody-positive survivors and 644 antibody-negative close contacts enrolled in the study at baseline, the majority of participants returned annually, with 383 (67.8%) and 407 (63.2%) participants, respectively, presenting for the final study visit at a median of 60 months after symptom onset. A sustained, relative decrease in IOP was observed in survivors relative to close contacts, with mean difference of -0.87 mmHg (95% confidence interval -1.24 to -0.51) across all follow-up study visits. This difference remained constant over time (p=0.23 for interaction over time). Among survivors, physical examination findings of vitreous cell, optical coherence tomography findings of vitreous opacities, and eyes with diagnosis of uveitis all demonstrated a significant association with decreased IOP at baseline (p<0.05 for all).

Conclusions : In this study, survivors of EVD experienced a sustained decrease in IOP relative to close contacts over a five-year period following EVD infection. Clinical implications are unknown, but further research is required to elucidate the physiological origin of such changes. The results highlight the importance of considering long-term sequelae of emerging infectious diseases within a population.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.