Efficacy and Safety Outcomes of Cataract Surgery in Survivors of Ebola Virus Disease: 12-Month Results From the PREVAIL VII Study

• Type of Material: Article
• Authors: Allen O. Eghrari, Johns Hopkins University; Jessica Shantha, Emory University; Robin D. Ross, Global Retina Institute; Collin Van Ryn, University of Minnesota; Ian Crozier, Frederick National Laboratory for Cancer Research; Brent Hayek, Emory University; Dan Gradin, Oregon Health and Science University; Ben Roberts, University of Alabama Birmingham; S. Grace Prakalapakorn, Duke University; Fred Amegashie, Ministry of Health, Monrovia, Liberia; Kumar Nishant, LV Prasad Eye Institute; Gurcharan Singh, LV Prasad Eye Institute; Robert Dolo, New Sight Eye Center; John Fankhauser, Eternal Love Winning Africa Hospital; Bryn Burkholder, Johns Hopkins University; James Pettitt, National Institute of Allergy and Infectious Diseases; Robin Gross, National Institute of Allergy and Infectious Disease; Tyler Brady, National Institute of Allergy and Infectious Diseases; Bonnie Dighero-Kemp, National Institute of Allergy and Infectious Diseases; Cavan Reilly, University of Minnesota; Lisa Hensley, National Institute of Allergy and Infectious Diseases; Elizabeth Higgs, National Institute of Allergy and Infectious Diseases; Steven Yeh, Emory University; Rachel J. Bishop, National Eye Institute
• Language: English
• Date: 2021-01-01
• Publisher: ARVO Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1167/tvst.10.1.32
• Title of Journal or Parent Work: Translational Vision Science & Technology
• Volume: 10
• Issue: 1
• Start Page: 1
• End Page: 12
• Grant/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;; Supported by an unrestricted departmental grant from Research to Prevent Blindness to the Emory Eye Center, Emory University School of Medicine.; NEI (award numbers K23 EY030158, JGS; RO1 EY029594, SY);; National Cancer Institute (Contract No. HHSN261200800001E, IC);; American Society of Cataract and Refractive Surgery Foundation grant (“Cataract Surgical Outcomes Among Survivors of Ebola Virus Disease,” AOE).; 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.
• Keywords: Ophthalmology; manual small incision cataract surgery; uveitis; Life Sciences & Biomedicine; Science & Technology; Ebola virus disease; cataract surgery
• Research Categories: Biology, Biostatistics; Health Sciences, Medicine and Surgery; Health Sciences, Opthamology; Health Sciences, Public Health

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.