Shantha Jessica G, Crozier Ian, Yeh Steven
aDepartment of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, USA bWorld Health Organization, Geneva, Switzerland cEmory Global Health Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
Curr Opin Ophthalmol. 2017 Nov;28(6):600-606. doi: 10.1097/ICU.0000000000000426.
This review provides a summary of our current understanding of the ophthalmic manifestations of Ebola virus disease (EVD), pathogenesis, treatment options and directions for future study. The individual, public health and global health implications of eye disease in EVD survivors are discussed.
The West Africa EVD outbreak was of unprecedented magnitude, leading to the largest survivor cohort since the first documented EVD outbreak in 1976. Because of the magnitude of the recent outbreak, thousands of survivors are at-risk of systemic and ophthalmic sequelae termed the 'post Ebola virus disease syndrome'. Uveitis is the most common finding during EVD convalescence and may lead to severe vision impairment or blindness in 40% of affected individuals. Ocular complications leading to vision loss include cataract, retinal scarring, optic neuropathy, hypotony and phthisis bulbi. The pathogenesis of eye disease in EVD survivors likely involves Ebola virus persistence, severe inflammation and tissue edema, which present as acute, rapidly progressive disease or chronic, smoldering disease. Further studies into disease pathogenesis including mechanisms of viral persistence may provide guidance into therapies for uveitis secondary to EVD.
Uveitis is the most common ophthalmic finding in EVD survivors and can lead to vision loss. Further studies into the clinical manifestations and mechanisms of disease are needed to improve therapies for EVD survivors who often have limited access to ophthalmic medical and surgical care.
本综述总结了我们目前对埃博拉病毒病(EVD)眼部表现、发病机制、治疗选择及未来研究方向的理解。讨论了EVD幸存者眼部疾病对个人、公共卫生和全球健康的影响。
西非的EVD疫情规模空前,形成了自1976年首次有记录的EVD疫情以来最大的幸存者群体。由于近期疫情规模巨大,数以千计的幸存者面临出现全身和眼部后遗症的风险,即所谓的“埃博拉病毒病后综合征”。葡萄膜炎是EVD康复期最常见的表现,40%的患者可能会导致严重视力损害或失明。导致视力丧失的眼部并发症包括白内障、视网膜瘢痕、视神经病变、低眼压和眼球痨。EVD幸存者眼部疾病的发病机制可能涉及埃博拉病毒持续存在、严重炎症和组织水肿,表现为急性、快速进展性疾病或慢性、隐匿性疾病。对疾病发病机制包括病毒持续存在机制的进一步研究可能为EVD继发葡萄膜炎的治疗提供指导。
葡萄膜炎是EVD幸存者最常见的眼部表现,可导致视力丧失。需要对疾病的临床表现和机制进行进一步研究,以改善EVD幸存者的治疗,这些幸存者往往难以获得眼科医疗和手术护理。