Paul J Steptoe1,2,3, Fayiah Momorie4, Alimamy D Fornah4, Sahr P Komba4, Elizabeth Emsley2, Janet T Scott1,3, Simon P Harding2,5, Matthew J Vandy6, Foday Sahr4, Nicholas A V Beare2,5, Malcolm G Semple1,3. 1. Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom. 2. St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom. 3. National Institute of Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom. 4. 34 Military Hospital, Freetown, Sierra Leone. 5. Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom. 6. Connaught Hospital, Freetown, Sierra Leone.
Abstract
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: 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.
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Authors: Paul J Steptoe; Janet T Scott; Julia M Baxter; Craig K Parkes; Rahul Dwivedi; Gabriela Czanner; Matthew J Vandy; Fayiah Momorie; Alimamy D Fornah; Patrick Komba; Jade Richards; Foday Sahr; Nicholas A V Beare; Malcolm G Semple Journal: Emerg Infect Dis Date: 2017-07 Impact factor: 6.883
Authors: Paul J Steptoe; Fayiah Momorie; Alimamy D Fornah; Patrick Komba; Elizabeth Emsley; Janet T Scott; Samantha J Williams; Simon P Harding; Matthew J Vandy; Foday Sahr; Nicholas A V Beare; Malcolm G Semple Journal: JAMA Ophthalmol Date: 2020-04-01 Impact factor: 7.389
Authors: Patrick J Howlett; Anna R Walder; Durodami R Lisk; Felicity Fitzgerald; Stephen Sevalie; Marta Lado; Abdul N'jai; Colin S Brown; Foday Sahr; Foday Sesay; Jonathon M Read; Paul J Steptoe; Nicholas A V Beare; Reena Dwivedi; Marylou Solbrig; Gibrilla F Deen; Tom Solomon; Malcolm G Semple; Janet T Scott Journal: Emerg Infect Dis Date: 2018-08 Impact factor: 6.883