Neuro-ophthalmic manifestations in a cohort of Ebola virus disease survivors from Sierra Leone: Ocular implications during convalescence

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.