SUMMARY Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are unknown. We describe a patient who recovered from EVD and was subsequently found to have severe unilateral uveitis during convalescence. Viable Zaire ebolavirus (EBOV) was detected in aqueous humor 14 weeks after the onset of EVD and 9 weeks after the clearance of viremia.

SUMMARYBackground-Limited data are available on the prevalence and predictors of clinical sequelae in survivors of Ebola virus disease (EVD). The EVD Survivor Clinic in Port Loko, Sierra Leone, has provided clinical care for 603 of 661 survivors living in the district. We did a cross-sectional study

1. Objective To describe the ocular findings, visual impairment, and association of structural complications of uveitis with visual impairment in a cohort of Ebola virus disease (EVD) survivors in Monrovia, Liberia 2. Design Retrospective, uncontrolled, cross-sectional study 3. Participants EVD survivors evaluated in an ophthalmology clinic at Eternal Love Winning Africa Hospital in Monrovia, Liberia. 4. Methods A cohort of EVD survivors who underwent baseline ophthalmic evaluation at ELWA Hospital were retrospectively reviewed for demographic information, length of Ebola treatment unit (ETU) stay, visual acuity (VA), and ophthalmic examination findings. For patients with uveitis, disease activity (active vs. inactive) and grade of inflammation were recording according to Standardization of Uveitis Nomenclature (SUN) criteria. The level of VA impairment was categorized according to World Health Organization classification for visual acuity impairment as follows: Normal/Mild – VA 20/70 or better; Moderate – VA 20/70–20/200; Severe VA 20/200–20/400; Blindness – VA < 20/400. VA, length of ETU stay, and structural complications were compared between EVD survivors with and without uveitis. Structural complications associated with moderate VA impairment or poorer were also analyzed. 5. Main Outcomes Frequency of ocular complications including uveitis and optic neuropathy in EVD survivors, level of visual acuity impairment in EVD survivors with uveitis, structural complications associated with visual acuity impairment in EVD survivors. 6. Results 96 EVD survivors were examined. 21 patients developed an EVD-associated uveitis and 3 patients developed an EVD-associated optic neuropathy. VA was blind (VA>20/400) in 38.5% of eyes with uveitis. Anatomic subtypes of uveitis included anterior, posterior, and panuveitis in 2, 13 and 6 patients respectively. Exam findings associated with at least moderate visual impairment by WHO criteria (VA<20/70) included keratic precipitates (p<0.002), posterior synechiae (p<0.002), vitritis (p<0.005) and chorioretinal scars (p<0.02). 7. Conclusions EVD survivors are at risk for uveitis, which may lead to secondary structural complications, visual impairment, and blindness. Eye care resources should be mobilized for EVD survivors in West Africa owing to the frequency of this spectrum of disease complication and its potential for severe VA impairment and blindness.

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