A Multi-Institutional Study on West Nile Virus Uveitis: Treatment, Complications, and Long-Term Outcomes

PURPOSE: West Nile virus (WNV) can cause anterior/intermediate uveitis with characteristic multifocal chorioretinal lesions. Literature on acute manifestations is robust; however there is limited data describing the full spectrum of uveitic manifestations of WNV, treatments in the acute and chronic phase, as well as long-term sequelae. METHODS: A retrospective observational study from three academic uveitis practices. Patients diagnosed with WNV based on serologic and imaging findings were selected; data collected included demographics, ocular and systemic co-morbidities, ophthalmic examination findings, and treatment. RESULTS: Eleven patients were included between 2015 to 2023, with a mean follow-up of 128 weeks (∼ 2.5 years). The average patient was a 60-year-old Caucasian (64%) woman (55%); 27% of patients had diabetes. Fifty-five percent presented with 20/20-20/40 Snellen visual acuity. Importantly, 73% of patients in this cohort were hospitalized due to encephalitis or meningitis. Acute findings included anterior inflammation (8 [36.4%] eyes), vitreous inflammation (9 [40.9%] eyes), cystoid macular edema (CME) (6 [27.3%] eyes), non-occlusive retinal vasculitis (5 [22.7%]), and 1 (4.5%) eye with occlusive retinal vasculitis. Two (9.1%) eyes developed secondary peripheral retinal neovascularization requiring anti-vascular endothelial growth factor treatment or laser panretinal photocoagulation. Eight (36.4%) eyes were initially treated with systemic steroids, and 4 (18.2%) eyes required immunomodulatory therapy (IMT) for recurrent CME and retinal vasculitis. CONCLUSION: WNV uveitis often has a self-limited course but can be intractable in some patients, with long-term control needed for CME and retinal vasculitis with systemic IMT. Ophthalmologists must be aware of the rarer complications that may require intervention.