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Jessica Shantha, Moges Teshome, John Mattia, Robert Garry, Matthew Jusu Vandy, Steven Yeh; Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) II Study:Cataract Surgery and RT-PCR Outcomes in Ebolavirus Disease Survivors. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3608. doi: https://doi.org/.
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Ebolavirus(EBOV) persistence after acute illness has been previously reported in the aqueous humor, which suggests the eye could be a potential reservoir for EBOV transmission. We report the baseline characteristics and visual outcomes of Ebolavirus Disease(EVD) survivors undergoing cataract surgery.
Baseline (cross-sectional) study from a prospective clinical cohort of EVD survivors with cataracts. Criteria for cataract surgery included: 1) negative EBOV PT-PCR anterior chamber paracentesis 2) visually significant cataract as determined by vision and ophthalmic exam. Patients were excluded if diagnosed with any ophthalmic condition that would preclude meaningful visual acuity improvement despite cataract surgery. Data collected consisted of demographic characteristics, ocular and medical history, and ophthalmic exam (slit lamp exam, dilated fundus exam, B-scan), serum EBOV IgG, and EBOV RT-PCR on intraocular fluid after removal of lens material. All surgeries were performed with strict infection control procedures for health care provider protection.
Sixteen patients (EBOV IgG positive) met eligibility criteria for surgery: 62.5% were female with an average age of 31 years (range:12-70). Mean time from discharge from an Ebola treatment unit was 21 months (range:13-31); 14 (87.5%) eyes had a history of uveitis; and, median pre-op visual acuity (VA) was 20/1260 (range:20/80-LP). 56.2% had cataracts in the right eye. Cataract types included age-related nuclear sclerotic (3), posterior subcapsular (3), cortical (2), uveitic white cataract (5), mature cataract (1), combination (2). Cataract extraction, synechiolysis and posterior chamber intraocular lens implantation was performed without complication in all eyes. The median post-operative day 1 (POD) VA was 20/60 (range: 20/20-hand motion,p<0.05) with continued improvement at post-operative month 1 with median VA 20/30 (n=9;p<0.05). Two patients experienced transient elevated intraocular pressure on POD 1, which resolved with ocular hypotensives. Intraocular fluid immediately after cataract extraction tested negative for EBOV by RT-PCR in all eyes.
Cataract surgery, with strict infection control guidance, was safe, effective, and led to meaningful visual restoration in EVD survivors. Further studies are needed given the public health impact to eye care providers and patients.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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