Suchergebnisse

IMPORTANCE: Differentiation between Ebola retinal lesions and other retinal pathologies in West Africa is important and the pathogenesis of Ebola retinal disease remains poorly understood. OBJECTIVE: To describe the appearance of Ebola virus disease (EVD) retinal lesions using multimodal imaging to enable inferences regarding potential pathogenesis. DESIGN: Consecutive, prospectively identified, cohort study SETTING: 34 Military Hospital, Freetown, Sierra Leone PARTICIPANTS: Fourteen EVD survivors of Sierra Leonean origin with identified Ebola virus retinal lesions. Mean age 37years (SD 8.8years) 43% Female. EXPOSURES: Ebola virus disease. MAIN OUTCOMES AND MEASURES: Multimodal imaging findings including ultra-widefield (UWF) scanning laser ophthalmoscopy, fundus autofluorescence, swept source optical coherence tomography (OCT), Humphrey visual field analysis, and spatial analysis. RESULTS: 141 Ebola virus retinal lesions were observed in 22 of 27 eyes of fourteen survivors on UWF imaging. 41 lesions were accessible to OCT imaging. Retinal lesions are predominantly non-pigmented with a pale grey appearance. Peripapillary lesions exhibit variable curvatures in keeping with the retinal nerve fiber layer projections. All lesions respect the horizontal raphe and spare the fovea. OCT demonstrates a 'V' shaped hyperreflectivity of the outer nuclear layer overlying discontinuities of the ellipsoid zone and interdigitation zone in the smaller lesions. Larger lesions cause a collapse of the retinal layers and loss of retinal thickness. Lesion shapes are variable but sharp angulations are characteristic. Perilesional areas of dark-without-pressure (thinned ellipsoid zone hyporeflectivity) of variable extent, accompany 89% of lesions. CONCLUSIONS AND RELEVANCE: We demonstrate OCT evidence of localized pathological changes seen at the level of the photoreceptors in small lesions. The relevance of associated areas of dark-without-pressure remains undetermined.

Importance: Differentiation between Ebola retinal lesions and other retinal pathologies in West Africa is important, and the pathogenesis of Ebola retinal disease remains poorly understood. Objective: To describe the appearance of Ebola virus disease (EVD) retinal lesions using multimodal imaging to enable inferences on potential pathogenesis. Design, Setting, and Participants: This prospective case series study was carried out at 34 Military Hospital in Freetown, Sierra Leone. Ophthalmological images were analyzed from 14 consecutively identified survivors of EVD of Sierra Leonean origin who had identified Ebola retinal lesions. Main Outcomes and Measures: Multimodal imaging findings including ultra-widefield scanning laser ophthalmoscopy, fundus autofluorescence, swept-source optical coherence tomography (OCT), Humphrey visual field analysis, and spatial analysis. Results: The 14 study participants had a mean (SD) age of 37.1 (8.8) years; 6 (43%) were women. A total of 141 Ebola retinal lesions were observed in 22 of 27 eyes (81%) of these 14 survivors on ultra-widefield imaging. Of these, 41 lesions (29.1%) were accessible to OCT imaging. Retinal lesions were predominantly nonpigmented with a pale-gray appearance. Peripapillary lesions exhibited variable curvatures in keeping with the retinal nerve fiber layer projections. All lesions respected the horizontal raphe and spared the fovea. The OCT imaging demonstrated a V-shaped hyperreflectivity of the outer nuclear layer overlying discontinuities of the ellipsoid zone and interdigitation zone in the smaller lesions. Larger lesions caused a collapse of the retinal layers and loss of retinal thickness. Lesion shapes were variable, but sharp angulations were characteristic. Perilesional areas of dark without pressure (thinned ellipsoid zone hyporeflectivity) accompanied 125 of the 141 lesions (88.7%) to varying extents. Conclusions and Relevance: We demonstrate OCT evidence of localized pathological changes at the level of the photoreceptors in small lesions among survivors of EVD with retinal lesions. The relevance of associated areas of dark without pressure remains undetermined.

IMPORTANCE: The 2-year ophthalmic sequelae of Ebola virus disease (EVD) in survivors of the 2013 to 2016 epidemic is unknown and may have public health implications for future outbreaks. OBJECTIVE: To assess the potential for uveitis recurrence, the behavior of dark without pressure, and visual outcomes in a cohort of Sierra Leonean survivors of EVD 2 years following the 2013 to 2016 Ebola epidemic. DESIGN, SETTING, AND PARTICIPANTS: Prospective, 1-year observational cohort study performed between 2016 and 2017 at 34 Military Hospital, Freetown, Sierra Leone. Participants included survivors of EVD who reported ocular symptoms since Ebola treatment unit discharge and were participants of a previous case-control study. Participants were invited for ophthalmic reexamination and finger-prick blood sampling for immunoglobulin G (IgG) to Toxoplasma gondii and HIV. EXPOSURES: Ebola virus disease. MAIN OUTCOMES AND MEASURES: Primary outcome measure: comparative ultra-widefield retinal imaging. Secondary outcome measures: visual acuity and detection of IgG to T gondii and HIV. RESULTS: Of 57 survivors of EVD who underwent repeated ophthalmic evaluation, 37 were women (64.9%). Mean (SD) age was 31.9 (11.1) years. Median interval between first and last examination was 370 days (interquartile range [IQR], 365-397.5 days), and median time from discharge to last examination was 779 days (IQR, 732-821 days). Fifteen eyes of 10 survivors (17.5%) had retinal lesions secondary to EVD. No new EVD-associated retinal lesions were observed. Two survivors (3.5%) developed new posterior uveitis resembling toxoplasmosis chorioretinitis and 41 (73%) were seropositive for T gondii IgG. Areas of dark without pressure were observed either confined to the perimeter of Ebola retinal lesions (n = 7) and non-Ebola lesions (n = 2), involving extensive retinal areas adjacent to Ebola retinal lesions (n = 4) and non-Ebola lesions (n = 2) or in isolation (n = 6). Both expansion and regression of areas of dark without pressure were observed over the ...