June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Aetiology and Management of Uveitis in a Viral Haemorrhagic Fever Zone (EMERGE) Study
Author Affiliations & Notes
  • Shiama Balendra
    King's College Global Health Partnership, King's College London, London, London, United Kingdom
    Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Lloyd Harrison-Williams
    Jui Hospital, Sierra Leone
  • Jalikatu Mustapha
    Connaught Hospital, Sierra Leone
  • Zikan Koroma
    Connaught Hospital, Sierra Leone
  • Alicious Kamara
    Connaught Hospital, Sierra Leone
  • Bangi Saradugu
    Connaught Hospital, Sierra Leone
  • Osman Conteh
    Connaught Hospital, Sierra Leone
  • Santigie Kamara
    Connaught Hospital, Sierra Leone
  • Huachun Wang
    Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Tolulope Fashina
    Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Jessica Shantha
    San Francisco State University, San Francisco, California, United States
  • Steven Yeh
    Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Alasdair Kennedy
    King's College Global Health Partnership, King's College London, London, London, United Kingdom
  • Footnotes
    Commercial Relationships   Shiama Balendra None; Lloyd Harrison-Williams None; Jalikatu Mustapha None; Zikan Koroma None; Alicious Kamara None; Bangi Saradugu None; Osman Conteh None; Santigie Kamara None; Huachun Wang None; Tolulope Fashina None; Jessica Shantha None; Steven Yeh None; Alasdair Kennedy None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 144. doi:
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      Shiama Balendra, Lloyd Harrison-Williams, Jalikatu Mustapha, Zikan Koroma, Alicious Kamara, Bangi Saradugu, Osman Conteh, Santigie Kamara, Huachun Wang, Tolulope Fashina, Jessica Shantha, Steven Yeh, Alasdair Kennedy; Aetiology and Management of Uveitis in a Viral Haemorrhagic Fever Zone (EMERGE) Study. Invest. Ophthalmol. Vis. Sci. 2023;64(8):144.

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

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Abstract

Purpose : Uveitis is a major cause of blindness worldwide, especially in countries located within haemorrhagic fever zones such as Sierra Leone. Studies on uveitis in Sierra Leone were conducted prior to the Ebola Virus Disease epidemic of 2013-16, which can cause uveitis in 20% of survivors, did not include imaging or investigation of viruses or tuberculosis and used laboratory services outside the country. We performed a cross-sectional study on a sample of patients presenting with all types of uveitis to establish their clinical characteristics and identify the impact of laboratory diagnoses to strengthen in-country laboratory systems.

Methods : We screened for uveitis cases presenting to Connaught and Kissy Hospital Eye Departments in Sierra Leone during March to September 2022. Cases diagnosed with active or inactive uveitis were invited to participate in the study and undergo a full diagnostic work-up. This involved history and examination, fundus photography and ocular coherence tomography assessment. Active uveitis cases underwent further investigations including immunological tests and chest radiographs.

Results : We recruited 128 patients. The mean age was 36±14 years and there was an equal gender split. Panuveitis was the predominant anatomical type of uveitis (n=51, 40%), followed by posterior uveitis (n=36, 28%). Active uveitis was identified in 75 (59%) of cases. Bilateral disease affected 40 patients (31%). Risk factors for uveitis included 9 (7%) HIV positive patients, 2 (2%) Ebola survivors and 48 (38%) patients with a history of associated trauma. From clinical examination alone, most cases were of undifferentiated aetiology (n=69, 53%), followed by toxoplasmosis (n=47, 37%). ICD 11 definition of blindness with VA<3/60 occurred in 33% (n=55) of uveitis eyes. Mean visual acuity of all uveitis eyes (n=168) was 6/60, and of the worse affected eyes only (n=128) was 6/90. Anterior uveitis eyes had significantly better visual acuity than intermediate, posterior and panuveitis (6/30 vs 6/110, p=0.013). Of the 32 patients tested, 32% were positive for Quantiferon TB, and 61 were positive for HSV IgG (88%).

Conclusions : Uveitis was associated with high levels of visual impairment in Sierra Leone. Posterior and panuveitis contributed to the highest proportion of uveitis cases. Further laboratory diagnostics will be performed to assess their correlation with clinical findings.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

 

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