Characterization of Ebola Virus-Associated Eye Disease

Abstract

Importance: Survivors of Ebola virus disease (EVD) may experience ocular sequelae. Comparison with antibody-negative individuals from the local population is required to characterize the disease.

Objective: To assess features of ophthalmic disease specific to EVD.

Design, setting, and participants: This baseline cross-sectional analysis of survivors of EVD and their close contacts was conducted within PREVAIL III, a 5-year, longitudinal cohort study. Participants who enrolled at John F. Kennedy Medical Center in Liberia, West Africa from June 2015 to March 2016 were included in this analysis. Close contacts were defined as household members or sex partners of survivors of EVD. Data were analyzed from July 2016 to July 2020.

Exposures: All participants, both survivors and close contacts, underwent testing of IgG antibody levels against Ebola virus surface glycoprotein.

Main outcomes and measures: Ocular symptoms, anterior and posterior ophthalmologic examination findings, and optical coherence tomography images were compared between antibody-positive survivors and antibody-negative close contacts.

Results: A total of 564 antibody-positive survivors (320 [56.7%] female; mean [SD] age, 30.3 [14.0] years) and 635 antibody-negative close contacts (347 [54.6%] female; mean [SD] age, 25.8 [15.5] years) were enrolled in this study. Survivors were more likely to demonstrate color vision deficit (28.9% vs 19.0%, odds ratio [OR], 1.6; 95% CI, 1.2-2.1) and lower intraocular pressure (12.4 vs 13.5 mm Hg; mean difference, -1.2 mm Hg; 95% CI, -1.6 to -0.8 mm Hg) compared with close contacts. Dilated fundus examination revealed a higher percentage of vitreous cells (7.8% vs 0.5%; OR, 16.6; 95% CI, 5.0-55.2) and macular scars (4.6% vs 1.6%; OR, 2.8; 95% CI, 1.4-5.5) in survivors than in close contacts. Uveitis was present in 26.4% of survivors and 12.1% of close contacts (OR, 2.4; 95% CI, 1.8-3.2). Among all participants with uveitis, survivors were more likely than close contacts to have intermediate uveitis (34.2% vs 6.5% of all cases; OR, 7.8; 95% CI, 3.1-19.7) and had thicker mean central subfield thickness on optical coherence tomography (222 vs 212 μm; mean difference, 14.4 μm; 95% CI, 1.9-26.9 μm).

Conclusions and relevance: In this cross-sectional study, survivors of EVD had a distinct spectrum of ocular and neuro-ophthalmologic findings compared with close contacts that potentially require medical and surgical treatment.

Figure 1.. Flowchart of Enrollment in the PREVAIL III Eye Substudy

Serologically confirmed status of both survivors of Ebola virus disease and their close contacts allowed for more accurate comparison across groups and determination of Ebola-specific pathology. JFK indicates John F. Kennedy Medical Center.

Figure 2.. Slitlamp Biomicroscopic Examination of Eyes Affected by Ebola Virus Disease

A, Posterior synechiae and pupillary membrane appeared in an eye with anterior uveitis. B, Pigment on the anterior lens capsule remained after lysis of synechiae with cycloplegic drops. C and D, Inflammatory cataracts in eyes with a history of uveitis included central, anterior lenticular opacity (C), and posterior subcapsular cataract (D). E, Vitreous cells and debris appeared in an eye with intermediate uveitis. F, As imaged through a 90-D lens, gliotic processes (arrowheads) are seen extending from the optic nerve in the eye of a survivor of Ebola virus disease.

Figure 3.. Optical Coherence Tomography of Eyes of Survivors of Ebola Virus Disease

A, Vitreous cells appeared as punctate opacities distributed through the vitreous gel. B, Vitreomacular traction appeared in a young male survivor with inflammatory membrane formation. C and D, Retinal lesions showed a multifocal distribution and on both multicolor (arrowheads) (C) and autofluorescence (D) images. E, These lesions characteristically affected the outer retina. F, Macular edema appeared in a diffuse pattern throughout the inner nuclear layer.