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

这项研究有三个目标： 1. 为利比里亚的埃博拉幸存者提供复明白内障手术。 2. 确定埃博拉病毒是否在白内障幸存者的眼组织中持续存在。这将有助于我们更好地了解病毒在体内的行为，并使我们能够为这一群体制定眼科手术的安全指南。 3. 研究埃博拉幸存者如何在白内障手术后愈合，与对照组相比。这将有助于确保未来接受手术的埃博拉幸存者获得最佳管理和视力结果。 在2017年秋季，24名埃博拉血清反应阳性的幸存者和10名血清反应阴性的密切接触者被纳入研究。血清反应阳性的幸存者首先接受了来自眼前房的液体，以确定眼液中是否有埃博拉病毒RNA的证据。使用仍在进行最终验证的检测试剂盒检测所有标本均为阴性。所有参与者随后接受标准白内障手术和人工透镜植入术。对参与者进行了为期一年的密切跟踪。其中两名参与者（一名幸存者和一名对照组）有晚期手术并发症，需要额外的手术治疗;两人都做得很好。 在白内障手术中收集的眼睛样本从利比里亚运到美国进行分析。实验室报告说，这些样本在储存过程中没有存活下来，无法从这些样本中得出可靠的结论，尽管在进行的测试中没有证据表明存在埃博拉病毒RNA。 分享该研究结果的手稿已提交出版，正在接受审查。 研究人员正在起草埃博拉相关白内障手术治疗的共识指南。 关于协作的说明：这项研究是学术界、政府、非政府组织、宗教组织和私人组织的多个实体的联合合作，包括：国立卫生研究院、约翰霍普金斯大学、埃默里大学、蒙罗维亚肯尼迪医院的LV普拉萨德/利比里亚眼科中心、蒙罗维亚的新视力眼科中心、蒙罗维亚的ELWA医院、撒玛利亚人基金会、约翰斯诺公司和利比里亚卫生部。 关于PREVAIL 3自然史研究的说明：PREVAIL 7埃博拉白内障方案的所有参与者也是PREVAIL 3埃博拉幸存者自然史研究的参与者。在PREVAIL 3研究中，我们跟踪了2,500多名埃博拉幸存者和密切接触者，以确定、治疗和了解埃博拉对眼睛的影响。这项研究表明，大约50%的幸存者和对照组由于环境原因而受到眼睛刺激，高达26%的埃博拉幸存者患有眼部并发症，包括葡萄膜炎（眼睛炎症）和白内障，而密切接触对照组约为12%。

This study had 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 viral RNA 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. The participants were followed closely for one year. 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 could be derived from the samples, though there was not suggestion of evidence of Ebola virus RNA in the tests which were performed. The manuscript sharing the study's findings has been submitted for publication and is undergoing review. The investigators are in the process of drafting consensus guidelines for surgical management of Ebola-associated cataract. 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 followed 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 26 percent of Ebola survivors have ocular complications, including uveitis (inflammation in the eye) and cataract, compared with about 12 percent of close contact controls.