Persistence of Ebola Virus in Aqueous Humor and Outcomes of Cataract Surgery in Survivors of Ebola Virus Disease

National Eye Institute

Investigators

Abstract

This study has three goals: 1. Provide sight-restoring cataract surgery to Ebola survivors in Liberia. 2. Determine whether Ebola virus persists in the eye tissues of survivors with cataracts. This will help us better understand how the virus behaves in the body, and allow us to develop safety guidelines for eye surgery in this group. 3. Study how Ebola survivors heal after cataract surgery compared with controls. This will help ensure the best management and vision outcomes in Ebola survivors undergoing surgery in the future. In the fall of 2017, 24 Ebola seropositive survivors and 10 seronegative close contact controls were enrolled in the study. The seropositive survivors first received a tap of fluid from the anterior chamber of the eye to determine whether there was evidence of Ebola virus in the eye fluid. All specimens tested negative using an assay that is still undergoing final validation. All participants then received standard cataract surgery with intraocular lens implantation. During the surgery, samples of anterior chamber fluid and lens material were collected for analysis. The participants are being followed closely, with the post-operative year-one exams due to take place in late September 2018. Two of the participants (one survivor and one control) had late surgical complications which required additional surgical management; both are doing well. The eye specimens that were collected during cataract surgery were shipped from Liberia to the United States for analysis. The laboratory reported that the samples did not survive the storage process and no reliable conclusions can be derived from the samples, though there was not suggestion of evidence of Ebola virus RNA in the tests which were performed. The investigators have drafted consensus guidelines for surgical management of Ebola-associated cataract and are preparing the manuscript for submission for publication. Note about collaboration : this research is a joint collaboration of multiple entities spanning academic, governmental, non-governmental, faith based, and private organizations including : the National Institutes of Health, Johns Hopkins University, Emory University, LV Prasad/the Liberian Eye Center at JFK Hospital in Monrovia, New Sight Eye Center in Monrovia, ELWA Hospital in Monrovia, Samaritans Purse, John Snow Incorporated, and the Liberian Ministry of Health. Note about the PREVAIL 3 Natural History Study: all participants on the PREVAIL 7 Ebola cataract protocol are also participants on the PREVAIL 3 Natural History Study of Ebola Survivors. In the PREVAIL 3 study, we follow more than 2,500 Ebola survivors and close contact controls in order to define, treat, and understand the effects of Ebola on the eye. This research has revealed that approximately 50 percent of survivors and controls have eye irritation due to environmental causes, and up to 25 percent of Ebola survivors have ocular complications, including uveitis (inflammation in the eye) and cataract, compared with about 10 percent of close contact controls.