• By Kanaga Rajan
    Cataract/Anterior Segment, Comprehensive Ophthalmology, Retina/Vitreous, Uveitis

    Cataract surgery can be safely performed on Ebola survivors, according to a study from scientists at Emory University School of Medicine and their international colleagues.

    The team systematically assessed the persistence of the Ebola virus in the ocular fluid of survivors and report vision outcomes after cataract surgery. Their study appeared in the April 2018 issue of EBioMedicine.

    “These findings are truly exciting, as they improve our ability to impact vision care and quality of life for thousands of Ebola survivors at risk for eye disease,” says Steven Yeh, MD, the M. Louise Simpson Associate Professor of Ophthalmology, Uveitis and Vitreoretinal Surgery at Emory.

    Dr. Yeh treated the first known case of ocular Ebola in 2015. His 43-year-old patient, Ian Crozier, MD, an Ebola virus survivor, presented with rapidly declining vision approximately 9 weeks after being declared Ebola-free. Upon further investigation, the clinicians discovered that it stemmed from a lingering Ebola infection in the eyes. The safety of invasive ophthalmic procedures for Ebola survivors and their physicians has been unclear ever since.

    Trying to resolve this uncertainty, this cross-sectional study screened 137 Ebola survivors from Sierra Leone and enrolled 50 with visually significant cataracts. The team tested aqueous humor and conjunctival fluid, sampled at a median of 19 and 34 months after Ebola diagnosis, and found no evidence of Ebola RNA. Thirty-four of the patients consented for manual small-incision cataract surgery with IOL implantation at the Lowell and Ruth Gess Eye Hospital in Freetown, Sierra Leone.

    Following surgery, all patients showed better vision. Median visual acuity improved from hand motions at baseline to 20/70 by the end of 1 month postop and further improved to 20/30 at 3 to 4 months.

    Their step-wise protocol, which features high-level safety precautions for preventing virus exposure, was designed to protect eye care providers and offers a step towards safe and efficient Ebola treatment and prevention. However, the study was small and not designed to determine if the eye harbored Ebola RNA at earlier time points, limitations that the authors say require further investigation before eye care providers can be assured about the safety of invasive ocular procedures.