Efficacy and safety outcomes of cataract surgery in survivors of ebola virus disease: 12-month results from the PREVAIL VII study

Allen O. Eghrari, Jessica G. Shantha, Robin D. Ross, Collin Van Ryn, Ian Crozier, Brent Hayek, Dan Gradin, Ben Roberts, S. Grace Prakalapakorn, Fred Amegashie, Kumar Nishant, Gurcharan Singh, Robert Dolo, John Fankhauser, Bryn Burkholder, James Pettitt, Robin Gross, Tyler Brady, Bonnie Dighero-Kemp, Cavan ReillyLisa Hensley, Elizabeth Higgs, Steven Yeh, Rachel J. Bishop

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: In survivors of Ebola virus disease (EVD), intraocular viral persistence raises questions about the timing and safety of cataract surgery. To the best of our knowledge, this is the first controlled study evaluating Ebola virus persistence and cataract surgery safety and outcomes in EVDsurvivors. Methods: Seropositive EVD survivors and seronegative controls with vision worse than 20/40 from cataract and without active intraocular inflammation were enrolled. Aqueous humor from survivors was tested with reverse transcription-polymerase chain reaction for Ebola viral RNA. Participants underwent manual small-incision cataract surgery and 1 year of follow-up examinations. Results: Twenty-two eyes of 22 survivors and 12 eyes of eight controls underwent cataract surgery. All of the aqueous samples tested negative for Ebola viral RNA.Median visual acuity improved from 20/200 at baseline to 20/25 at 1 year in survivors and from count fingers to 20/50 in controls (overall, P < 0.001; between groups, P = 0.07). After a 1-month course of topical corticosteroids, 55% of survivors and 67% of controls demonstratedat least 1+anterior chamber cell. Twelve months after surgery, optical coherence tomography revealed a median increase in macular central subfield thickness of 42 µm compared with baseline (overall, P = 0.029; between groups, P = 0.995). Conclusions: EVD survivors and controls demonstrated significant visual improvement fromcataract surgery. The persistence of intraocular inflammation highlights the importance of follow-up. The absence of detectable intraocular Ebola viral RNA provides guidance regarding the safety of eye surgery in Ebola survivors. Translational Relevance: These findings demonstrate the safety and efficacy of cataract surgery in Ebola survivors and will inform ocular surgery guidelines in this population.

Original languageEnglish (US)
Article number32
Pages (from-to)1-12
Number of pages12
JournalTranslational Vision Science and Technology
Volume10
Issue number1
DOIs
StatePublished - Jan 2021

Bibliographical note

Funding Information:
The authors thank Beth Thompson and Karen Daniels of Samaritan?s Purse International Relief for surgical planning and onsite surgical logistics and operations, and we thank Samaritan?s Purse for provision of surgical equipment and supplies. We thank Eternal Love Winning Africa Hospital and staff in Monrovia, Liberia, for support to surgical operations and providing accommodations to patients. We thank the L V Prasad Eye Institute in Hyderabad, India and L V Prasad Eye Institute?s Liberian Eye Center in Monrovia, Liberia, for help with providing postoperative care to patients. We thank the Liberian Institute for Biomedical Research laboratory in Monrovia, Liberia, for sample processing. We thank Jeff Sanderson of John Snow Incorporated for help with project coordination. We thank the US Agency for International Development for support through the Ebola Transmission Prevention and Survivor Services Program. We thank Catherine Gargu, Yassah Sosu, Jennie Sackor, Precious Cooper, Augustine Wallace, Ruth Nyain, Famatta Kamara, James Mulbah, Mercy Bowulo, Zipporah Cheburet, Dennis Kipkorir, Emily Chepkoech, Robert Koskey, John Troke, Alison Jordan, RickWood, Bev Kauffeldt, and Emmanuel Nyah for help caring for and communicating with study participants. Finally, we thank the SocialMobilization Team for coordinating participant visits. Supported in part by the Division of Intramural Research of the National Institute of Allergy and Infectious Disease (NIAID) and the National Eye Institute (NEI) of the National Institutes of Health; by the NEI (award numbers K23 EY030158, JGS; RO1 EY029594, SY); by the National Cancer Institute (Contract No. HHSN261200800001E, IC); and by an American Society of Cataract and Refractive Surgery Foundation grant (?Cataract Surgical Outcomes Among Survivors of Ebola Virus Disease,? AOE). Supported by an unrestricted departmental grant from Research to Prevent Blindness to the Emory Eye Center, Emory University School of Medicine. NIAID and NEI participated in the design of the study and conducting the study. Other sponsors and funding organizations had no role in the design or conduct of this research.

Funding Information:
Supported by an unrestricted departmental grant from Research to Prevent Blindness to the Emory Eye Center, Emory University School of Medicine. NIAID and NEI participated in the design of the study and conducting the study. Other sponsors and funding organizations had no role in the design or conduct of this research.

Funding Information:
The authors thank Beth Thompson and Karen Daniels of Samaritan’s Purse International Relief for surgical planning and onsite surgical logistics and operations, and we thank Samaritan’s Purse for provision of surgical equipment and supplies. We thank Eternal Love Winning Africa Hospital and staff in Monrovia, Liberia, for support to surgical operations and providing accommodations to patients. We thank the L V Prasad Eye Institute in Hyderabad, India and L V Prasad Eye Institute’s Liberian Eye Center in Monrovia, Liberia, for help with providing postoperative care to patients. We thank the Liberian Institute for Biomedical Research laboratory in Monrovia, Liberia, for sample processing. We thank Jeff Sanderson of John Snow Incorporated for help with project coordination. We thank the US Agency for International Development for support through the Ebola Transmission Prevention and Survivor Services Program. We thank Catherine Gargu, Yassah Sosu, Jennie Sackor, Precious Cooper, Augustine Wallace, Ruth Nyain, Famatta Kamara, James Mulbah, Mercy Bowulo, Zipporah Cheburet, Dennis Kipkorir, Emily Chepkoech, Robert Koskey, John Troke, Alison Jordan, Rick Wood, Bev Kauffeldt, and Emmanuel Nyah for help caring for and communicating with study participants. Finally, we thank the Social Mobilization Team for coordinating participant visits.

Funding Information:
Supported in part by the Division of Intramural Research of the National Institute of Allergy and Infectious Disease (NIAID) and the National Eye Institute (NEI) of the National Institutes of Health; by the NEI (award numbers K23 EY030158, JGS; RO1 EY029594, SY); by the National Cancer Institute (Contract No. HHSN261200800001E, IC); and by an American Society of Cataract and Refractive Surgery Foundation grant (“Cataract Surgical Outcomes Among Survivors of Ebola Virus Disease,” AOE).

Publisher Copyright:
© 2021 The Authors.

Keywords

  • Cataract surgery
  • Ebola virus disease
  • Manual small incision cataract surgery
  • Uveitis

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