Ebola Survivors at Higher Risk for Uveitis

JANUARY 30, 2017
Jared Kaltwasser
An analysis of Ebola survivors in West Africa suggests patients who contract the virus are at a higher risk of developing uveitis, and possibly even going blind.
 
Researchers from the Emory Eye Institute in Atlanta and the Eternal Love Winning Africa (ELWA) Hospital in Monrovia, Liberia, partnered together to examine 96 Liberian survivors of Ebola Virus Disease (EVD). The scientists wanted to ascertain the link between EVD and ophthalmic complications.
 
“Previous outbreaks have provided limited information on the long-term sequelae after EVD,” said Steven Yeh, MD, associate professor of Ophthalmology in the Emory University School of Medicine, in a press release. “Being able to work with survivors now gives us many opportunities to understand the ophthalmic and systemic sequelae that affects survivors after recovery from their acute illness.”
 
Of the 96 survivors examined at ELWA Hospital, 21 developed EVD-associated uveitis, and three developed EVD-associated optic neuropathy.
 
Most of the 21 patients (13) developed posterior uveitis. Six patients had panuveitis, and only two had anterior uveitis. Among all of the patients diagnosed with uveitis, nearly four in 10 (38.5%) became legally blind.
 
“Cataract and vitreous opacities were identifiable causes of vision loss in our patient cohort,” Yeh said. “These findings have implications from medical and surgical perspectives, particularly given our prior finding of live Ebola virus in the ocular fluid of a recovered Ebola survivor.”
 
As Yeh suggested, scientists have been eager to look more closely at eye problems in the wake of the 2013 Ebola outbreak.
 
A study published in November by researchers from the University of Massachusetts Medical Center also looked at uveitis and Ebola, and concluded that one possible cause of uveitis cases was the immune response to EVD.
 
“It remains unclear whether EVD-associated uveitis is caused by cytopathic effect of the virus or immune response, but early use of systemic corticosteroids appears to be beneficial, and sampling of intraocular fluid might not be necessary in patients who clinically improve with medical therapy,” concluded the authors, led by corresponding author Olga Ceron, MD.
 
The rate of legal blindness among the participants in the Emory study was significantly higher than the rate of uveitis patients who went blind in a general-population study published in the British Journal of Ophthalmology in 2004. In that study, which examined 325 patients over a course of two years, only 22% of uveitis patients met the standard of legal blindness at some point during their follow-up. The authors noted that of all of the major causes of blindness, only diabetes and uveitis are treatable.
 
As for Ebola, researchers are focusing on preventing future outbreaks. A study published last month in The Lancet found a proposed EVD vaccine to be 100% effective, heightening hopes for eradication of the disease. The most recent outbreak, which began in December 2013, led to more than 28,000 cases of EVD in Guinea, Liberia, and Sierra Leone, and caused more than 10,000 deaths. The World Health Organization declared the outbreak over in January 2016.
 
The Emory study, titled “Ophthalmic Manifestations and Causes of Vision Impairment in Ebola Virus Disease Survivors in Monrovia, Liberia”, was published in the December issue of Ophthalmology.
 
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