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 Reilly, Lisa Hensley, Elizabeth Higgs, Steven Yeh, Rachel J Bishop, 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 Reilly, Lisa Hensley, Elizabeth Higgs, Steven Yeh, Rachel J Bishop
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 EVD survivors.
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 demonstrated at 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 from cataract 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.
Keywords: Ebola virus disease; cataract surgery; uveitis, manual small incision cataract surgery.
Conflict of interest statement
Disclosure: A.O. Eghrari, None; J.G. Shantha, None; R.D. Ross, None; C. Van Ryn, None; I. Crozier, None; B. Hayek, None; D. Gradin, None; B. Roberts, None; S.G. Prakalapakorn, None; F. Amegashie, None; K. Nishant, None; G. Singh, None; R. Dolo, None; J. Fankhauser, None; B. Burkholder, None; J. Pettitt, None; R. Gross, None; T. Brady, None; B. Dighero-Kemp, None; C. Reilly, None; L. Hensley, None; E. Higgs, None; S. Yeh, None; R.J. Bishop, None
Copyright 2021 The Authors.
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References
- PREVAIL III Study Group, Sneller MC, Reilly C, et al. .. A longitudinal study of Ebola sequelae in Liberia. N Engl J Med. 2019; 380(10): 924–934.
- Shantha JG, Mattia JG, Goba A, et al. .. Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study: reverse transcription-polymerase chain reaction and cataract surgery outcomes of Ebola survivors in Sierra Leone. EBioMedicine. 2018; 30: 217–224.
- Eghrari AO, Bishop RJ, Ross RD, et al. .. Characterization of Ebola virus-associated eye disease. JAMA Network Open. 2021; 4(1): e2032216.
- Varkey JB, Shantha JG, Crozier I, et al. .. Persistence of Ebola virus in ocular fluid during convalescence. N Engl J Med; 2015; 372(25): 2423–2427.
- Aruna A, Mbala P, Minikulu L, et al. .. Ebola virus disease outbreak – Democratic Republic of the Congo, August 2018 – November 2019. MMWR Morb Mortal Wkly Rep. 2019; 20; 68(50): 1162–1165.
- Centers for Disease Control and Prevention. 2014-2016 Ebola Outbreak in West Africa. Available at: . Accessed May 6, 2020.
- Bishop RJ, Eghrari AO. Eye disease in EVD survivors in Liberia (PREVAIL III Study). In: WHO Meeting on Survivors of Ebola Virus Disease: Clinical Care of Survivors, Meeting Report. Geneva, Switzerland: World Health Organization; 2015.
- Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005; 140(3): 509–516.
- Pettitt J, Fallah M, Nason M, et al. .. Assessment and optimization of the GeneXpert diagnostic platform for detection of Ebola virus RNA in seminal fluid. J Infect Dis. 2017; 215(4): 547–553.
- Shantha JG, Crozier I, Varkey JB, et al. .. Long-term management of panuveitis and iris heterochromia in an Ebola survivor. Ophthalmology. 2016; 123(12): 2626–2628.
- Haripriya A, Chang DF, Reena M, et al. .. Complication rates of phacoemulsification and manual small-incision cataract surgery at Aravind Eye Hospital. J Cataract Refract Surg. 2012; 38(8): 1360–1369.
- Venkatesh R, Muralikrishnan R, Balent LC, et al. .. Outcomes of high volume cataract surgeries in a developing country. Br J Ophthalmol. 2005; 89(9): 1079–1083.
- Ghosh S, Roy I, Biswas P, et al. .. Prospective randomized comparative study of macular thickness following phacoemulsification and manual small incision cataract surgery. Acta Ophthalmol. 2010; 88(4): e102–e106.
- Mentes J, Erakgun T, Afrashi F, et al. .. Incidence of cystoid macular edema after uncomplicated phacoemulsification. Ophthalmologica. 2003; 217(6): 408–412.
- Biro Z, Balla Z, Kovacs B.. Change of foveal and perifoveal thickness measured by OCT after phacoemulsification and IOL implantation. Eye. 2008; 22(1): 8–12.
Source: PubMed