Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study: Ebolavirus RT-PCR Results and Cataract Surgery Outcomes

Abstract

Purpose : Ebola virus disease (EVD) survivors are at-risk for sight-threatening uveitis that may be due to viral persistence. The EVICT Study aims to determine the prevalence of EBOV RNA detection in ocular fluids and to establish the safety, feasibility, and outcomes of cataract surgery in EVD survivors.

Methods : The EVICT Study enrolled survivors requiring ophthalmic surgery. Demographics, ocular and medical history were collected, and an ophthalmic exam performed. Laboratory investigations included EBOV RT-PCR on ocular fluid (performed in high-level safety facility using full personal protective equipment), EBOV IgG, and antibody testing for HIV and syphilis infection. Patients requiring cataract surgery and without contraindication underwent manual small incision cataract surgery (MSICS) and were evaluated at 6 weeks and 3 months.

Results : 76 EVD survivors were screened and 27 were enrolled. Median age was 19 years (interquartile range [IQR]:15-34) and 67% were female. Median time from EVD diagnosis was 34.5 months (IQR:14-49). Indication for enrollment was visually significant cataract (25), blind painful eye (1), and subluxed lens (1). Median visual acuity (VA) was 3 (IQR:2.25-3) with the left eye affected in 20 (74%) patients. Cataract type included uveitic white cataract (16,64%), fibrotic anterior capsular plaque (4,16%), combination nuclear sclerotic/posterior subcapsular (2,8%), posterior subcapsular (2,8%), and cortical (1,4%). 20 (74%) patients required a B-scan. Signs of uveitis were noted in 26 study eyes. Ocular fluid tested negative for EBOV RNA by RT-PCR in all 27 patients. MSICS with lens implantation was performed in 16 eyes. One patient underwent enucleation. All patients were anti-EBOV IgG antibody positive. HIV antibody was detected in 1 patient and RPR testing was negative in all patients. Median Preoperative logMAR VA was 3 (IQR 2.25-3) with improvement at 6 weeks to 1.39 (IQR 0.55-2.00,P<0.0001) and 3 months to 0.60 (IQR 0.23-2.00,P<0.0005).

Conclusions : EBOV RNA was not detected in EVD survivors with inactive uveitis and cataracts requiring ocular surgery. Complications from uveitis resulted in cataract blindness in the majority of affected eyes, but cataract surgery was feasible, safe, and restored vision. These findings have important implications for EVD survivors and their eye care providers.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.