Ophthalmic manifestations and vision impairment in Lassa fever survivors

• Type of Material: Article
• Authors: Alexa L. Li, Emory University; Donald Grant, Kenema Government Hospital; Michael Gbakie, Kenema Government Hospital; Lansana Kanneh, Kenema Government Hospital; Ibrahim Mustafa, Kenema Government Hospital; Neil Bond, Tulane University; Emily Engel, Tulane University; John Schieffelin, Tulane University; Matthew J. Vandy, Ministry of Health and Sanitation, National Eye Program; Steven Yeh, Emory University; Jessica Shantha, Emory University
• Language: English
• Date: 2020-12-10
• Publisher: PUBLIC LIBRARY SCIENCE
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Li et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0243766
• Title of Journal or Parent Work: PLOS ONE
• Volume: 15
• Issue: 12
• Start Page: e0243766
• End Page: e0243766
• Grant/Funding Information: This project was supported by the National Eye Institute/ National Institutes of Health core grant P30-EY06360 (Department of Ophthalmology, Emory University School of Medicine), National Eye Institute, National Institutes of Health RO1 EY029594 (SY) and K23 EY030158 (JGS). Funding support was also provided via an Unrestricted Grant from Research to Prevent Blindness (Emory Eye Center, Emory University School of Medicine). Funding support was also provided by the Retina Research Foundation - Mills and Margaret Cox Macula Society Grant (SY), Bayer Global Ophthalmology Awards Program (SY; JGS), Santen, Inc, and the Sitaraman Family Foundation. The National Institute of Allergy and Infectious Disease under award number 1R01AI123535-01A1 (JS; DG) also provided funding support. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
• Keywords: POPULATION; EBOLA-VIRUS; EYE; LYMPHOCYTIC CHORIOMENINGITIS VIRUS; Science & Technology; EPIDEMIOLOGY; Science & Technology - Other Topics; CHORIORETINITIS; MANAGEMENT; CLINICAL-FEATURES; DIAGNOSIS; Multidisciplinary Sciences; BLINDNESS
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

The purpose of this study was to describe the ocular findings, structural ocular complications, and vision impairment in a cohort of Lassa fever survivors in Kenema, Sierra Leone. A retrospective, uncontrolled, cross-sectional study of 31 Lassa fever survivors (62 eyes) who underwent an ophthalmic evaluation in January 2018 at the Kenema Government Hospital in Kenema, Sierra Leone was performed. Data collection included demographic information, ocular/systemic symptoms, visual acuity (VA), and ophthalmic examination findings. Main outcome measures included anterior and posterior segment ophthalmic manifestations and level of VA impairment in Lassa fever survivors. Anterior segment findings included cataract (18%) and pterygium (2%), while posterior segment manifestations consisted of glaucoma (6%), preretinal hemorrhage (2%), and lattice degeneration (2%). Findings suggestive of prior sequelae of uveitis included chorioretinal scarring (5%), retinal fibrosis (3%), and vitreous opacity (2%). Visual acuity was normal/mildly impaired in 53 eyes (85%), moderately impaired in 6 eyes (10%), and 3 eyes (5%) were considered blind by the World Health Organization (WHO) criteria. Median VA was worse in Lassa fever survivors with ophthalmic disease findings (p<0.0001) for both anterior segment (p<0.0001) and posterior segment disease (p<0.013). Untreated cataract was a significant cause of visual acuity impairment (p<0.0001). Lassa fever survivors in this cohort were found to have cataract and posterior segment findings that potentially represent sequelae of uveitis associated with visual impairment. Future studies are warranted to improve our understanding of the spectrum of ocular disease in this emerging infectious disease of public health consequence.