Ebola virus persistence in aqueous humor and 12-month outcomes of cataract surgery in survivors of Ebola virus disease

Abstract

Purpose : Approximately 10% of Ebola virus disease (EVD) survivors examined in Liberia presented with cataract. Surgical parameters in EVD survivors are unknown, including whether Ebola virus (EBOV) persists in aqueous humor, degree of post-operative inflammation, and potential for vision improvement. We assessed the presence of Ebola virus RT-PCR in aqueous humor of survivors and performed cataract surgery on EVD survivors and controls to compare post-op inflammation and visual rehabilitation.

Methods : The PREVAIL 7 Ebola Cataract Study is a prospective, controlled study that assessed eyes of survivors for Ebola virus persistence and cataract surgery outcomes. Anterior chamber (AC) taps were performed in sero-positive EVD survivors who were without intraocular inflammation to assess EBOV RT-PCR prior to surgery. 22 EVD survivors with negative AC taps and 8 control participants underwent small incision cataract surgery (SICS) with intraocular lens (IOL) placement. Follow-up exams were performed at day 1, week 1, and months 1, 3, 6, 9, and 12. We compare visual acuity (VA), degree of inflammation, and complications between survivors and controls.

Results : AC taps were negative for all EVD survivors. VA improved significantly in both survivors and controls (P<0.001). Mean VA improved from 20/200 at baseline to 20/40 at 1 year in survivors and from 20/1400 to 20/63 in controls. AC inflammation (grade 2 or greater by SUN criteria) was comparable between groups, persisting in 55% of survivors and 67% of controls at 1 month, 14% of survivors and 30% of controls at 6 months, and resolving in all participants by 1 year with extended anti-inflammatory therapy (P>0.05 for 1-, 6-, and 12-month between group comparisons). Complication rates were similar between groups, including IOL subluxation in one survivor and IOL subluxation with retinal detachment in one control, both requiring additional surgery.

Conclusions : EBOV was not detected in aqueous of survivors by RT-PCR. Cataract surgery via SICS was safe and feasible, resulting in improved vision and comparable complication rates between survivors and controls. Anti-inflammatory therapy was successful, often involving treating extended inflammation in both groups. This prospective, controlled study highlights VA benefit with a systematic approach to vision restorative surgery for EVD survivors.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.