Neuro-ophthalmic manifestations in a cohort of Ebola virus disease survivors from Sierra Leone: Ocular implications during convalescence
Nam V. Nguyen,
Tolulope Fashina,
Ye Huang,
Casey Randleman,
Jean-Claude Mwanza,
Jalikatu Mustapha,
Matthew Jusu Vandy,
Lloyd Harrison-Williams,
Brent R. Hayek,
Ian Crozier,
Rod Foroozan,
Jessica G. Shantha,
Steven Yeh
Affiliations
Nam V. Nguyen
College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States; Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
Tolulope Fashina
Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
Ye Huang
College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States; Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
Casey Randleman
Rollins School of Public Health, Emory University, Atlanta, GA, United States
Jean-Claude Mwanza
Department of Ophthalmology, University of North Carolina, Chapel Hill, NC, United States
Jalikatu Mustapha
Ministry of Health and Sanitation, National Eye Program, Freetown, Sierra Leone
Matthew Jusu Vandy
Ministry of Health and Sanitation, National Eye Program, Freetown, Sierra Leone
Lloyd Harrison-Williams
Ministry of Health and Sanitation, National Eye Program, Freetown, Sierra Leone
Brent R. Hayek
Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
Ian Crozier
Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
Rod Foroozan
Division of Neuro-Ophthalmology, Baylor College of Medicine, Houston, TX, United States
Jessica G. Shantha
Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States; F.I. Proctor Foundation, Department of Ophthalmology, University of California San Francisco, San Francisco, CA, United States
Steven Yeh
Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States; Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States; Corresponding author. Chair in Ophthalmology Director of Retina and Uveitis, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States.
Background: We aim to characterize the spectrum of neuro-ophthalmic manifestations and their impact on visual acuity in a cohort of Ebola virus disease (EVD) survivors from the Western African outbreak from 2013 to 2016. Methods: Patients, who previously underwent screening for enrollment in the Ebola Virus Persistence in Ocular Tissues and Fluids Study (EVICT study), were eligible for this post-hoc analysis. A review of collected data was performed, and neuro-ophthalmic manifestations including afferent pupillary defect, motility problems, and optic nerve diseases (optic pallor or atrophy) were analyzed. Statistical analysis was performed using Microsoft Excel (Microsoft Corporation, Redmond, WA); a p-value <0.05 was considered significant. Findings: A total of 184 eyes of 115 patients were included in the analysis. The mean age was 32·2 ± 15·8 years, and the mean logMAR was 0·34 ± 0·68; Snellen visual acuity of 20/40. Of 184 eyes, twelve (6·5 %) eyes of 8 patients had optic nerve diseases, of which 4 had bilateral disease. The mean logMAR was significantly worse in patients with optic nerve disease (1·46 ± 1·21) than in those without (0·26 ± 0·55), p-value = 0·008. Ocular motility issues were identified in 11 of 115 patients (9·6 %), which included exotropia (n = 9), esotropia (n = 1), and vertical gaze palsy (n = 1). Interpretation: In this post-hoc analysis, we identified a subset of EVD survivors with optic nerve diseases and motility disorders. Patients with optic nerve pathology showed worse visual acuity with severe vision impairment and rare association with neurologic symptoms.
