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Shantha JG, Mattia JG, Goba A, Barnes KG, Ebrahim FK, Kraft CS, Hayek BR, Hartnett JN, Shaffer JG, Schieffelin JS, Sandi JD, Momoh M, Jalloh S, Grant DS, Dierberg K, Chang J, Mishra S, Chan AK, Fowler R, O'Dempsey T, Kaluma E, Hendricks T, Reiners R, Reiners M, Gess LA, ONeill K, Kamara S, Wurie A, Mansaray M, Acharya NR, Liu WJ, Bavari S, Palacios G, Teshome M, Crozier I, Farmer PE, Uyeki TM, Bausch DG, Garry RF, Vandy MJ, Yeh S. Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study: Reverse Transcription-Polymerase Chain Reaction and Cataract Surgery Outcomes of Ebola Survivors in Sierra Leone. EBioMedicine 2018; 30:217-224. [PMID: 29622497 PMCID: PMC5952345 DOI: 10.1016/j.ebiom.2018.03.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 03/16/2018] [Accepted: 03/17/2018] [Indexed: 12/01/2022] Open
Abstract
Background Ebola virus disease (EVD) survivors are at risk for uveitis during convalescence. Vision loss has been observed following uveitis due to cataracts. Since Ebola virus (EBOV) may persist in the ocular fluid of EVD survivors for an unknown duration, there are questions about the safety and feasibility of vision restorative cataract surgery in EVD survivors. Methods We conducted a cross-sectional study of EVD survivors anticipating cataract surgery and patients with active uveitis to evaluate EBOV RNA persistence in ocular fluid, as well as vision outcomes post cataract surgery. Patients with aqueous humor that tested negative for EBOV RNA were eligible to proceed with manual small incision cataract surgery (MSICS). Findings We screened 137 EVD survivors from June 2016 – August 2017 for enrolment. We enrolled 50 EVD survivors; 46 with visually significant cataract, 1 with a subluxated lens, 2 with active uveitis and 1 with a blind painful eye due to uveitis. The median age was 24.0 years (IQR 17–35) and 35 patients (70%) were female. The median logMAR visual acuity (VA) was 3.0 (Snellen VA Hand motions; Interquartile Range, IQR: 1.2-3.0, Snellen VA 20/320 – Hand motions). All patients tested negative for EBOV RNA by RT-PCR in aqueous humor/vitreous fluid and conjunctiva at a median of 19 months (IQR 18-20) from EVD diagnosis in Phase 1 of ocular fluid sampling and 34 months (IQR 32-36) from EVD diagnosis in Phase 2 of ocular fluid sampling. Thirty-four patients underwent MSICS, with a preoperative median VA improvement from hand motions to 20/30 at three-month postoperative follow-up (P < 0.001). Interpretation EBOV persistence by RT-PCR was not identified in ocular fluid or conjunctivae of fifty EVD survivors with ocular disease. Cataract surgery can be performed safely with vision restorative outcomes in patients who test negative for EBOV RNA in ocular fluid specimens. These findings impact the thousands of West African EVD survivors at-risk for ocular complications who may also require eye surgery during EVD convalescence. Ebola virus disease (EVD) survivors are at-risk for severe vision impairment due to uveitis and subsequent cataract development. Fifty EVD survivors underwent ocular fluid sampling and tested negative for Ebola virus by RT-PCR. Thirty-four survivors underwent cataract surgery with excellent safety measures and vision restorative outcomes.
Ebola virus disease (EVD) survivors are at high risk for uveitis, an inflammatory condition affecting the eye that may lead to severe vision impairment, often from cataract. Because persistent Ebola virus (EBOV) has been identified within the immune privileged eye, understanding the prevalence of intraocular EBOV persistence is significant for patients, providers, and public health policy. In this study, 50 EVD survivors tested negative for EBOV by RT-PCR of their intraocular fluid. Thirty-four underwent cataract surgery with vision restorative outcomes. These findings improve our ability to impact vision care and quality-of-life for thousands of EVD survivors at-risk for eye disease.
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Affiliation(s)
- Jessica G Shantha
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA, United States; University of California San Francisco, Proctor Foundation, San Francisco, CA, United States
| | - John G Mattia
- Lunsar Baptist Eye Hospital, Port Loko, Sierra Leone
| | - Augustine Goba
- Kenema Government Hospital Lassa Hemorrhagic Fever Laboratory, Kenema, Sierra Leone
| | - Kayla G Barnes
- Department of Organismic and Evolutionary Biology, Harvard University, United States; Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | | | - Colleen S Kraft
- Department of Pathology and Laboratory Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, United States
| | - Brent R Hayek
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Jeffrey G Shaffer
- Department of Biostatistics and Bioinformatics, Tulane School of Public Health, New Orleans, LA, United States
| | | | - John D Sandi
- Kenema Government Hospital Lassa Hemorrhagic Fever Laboratory, Kenema, Sierra Leone
| | - Mambu Momoh
- Kenema Government Hospital Lassa Hemorrhagic Fever Laboratory, Kenema, Sierra Leone
| | - Simbirie Jalloh
- Kenema Government Hospital Lassa Hemorrhagic Fever Laboratory, Kenema, Sierra Leone
| | - Donald S Grant
- Kenema Government Hospital Lassa Hemorrhagic Fever Laboratory, Kenema, Sierra Leone; Department of Community Health, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Joyce Chang
- Partners in Health, Boston, MA, United States
| | | | | | - Rob Fowler
- University of Toronto, Toronto, ON, Canada
| | | | - Erick Kaluma
- Comprehensive Program for Ebola Survivors, Freetown, Sierra Leone
| | - Taylor Hendricks
- Comprehensive Program for Ebola Survivors, Freetown, Sierra Leone
| | - Roger Reiners
- Lowell and Ruth Gess Eye Hospital, Freetown, Sierra Leone
| | | | - Lowell A Gess
- Lowell and Ruth Gess Eye Hospital, Freetown, Sierra Leone
| | | | | | - Alie Wurie
- Ministry of Health and Sanitation, Sierra Leone
| | - Mohamed Mansaray
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | - Nisha R Acharya
- University of California San Francisco, Proctor Foundation, San Francisco, CA, United States
| | - William J Liu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sina Bavari
- United Stated Army Medical Research Institute of Infectious Diseases, Frederick, MD, United States
| | - Gustavo Palacios
- United Stated Army Medical Research Institute of Infectious Diseases, Frederick, MD, United States
| | - Moges Teshome
- Lowell and Ruth Gess Eye Hospital, Freetown, Sierra Leone; Christian Blind Mission International, Washington, D.C., United States
| | - Ian Crozier
- Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | | | - Timothy M Uyeki
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Daniel G Bausch
- UK Public Health Rapid Support Team Public Health England/London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert F Garry
- Tulane University School of Medicine, New Orleans, LA, United States
| | | | - Steven Yeh
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA, United States; Emory Global Health Institute, Emory University, Atlanta, GA, United States.
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Mansaray M, Hynd JW, Vergroesen I, Belcher PR, Drake-Holland AJ, Noble MI. Thrombosis in one coronary artery causes generalized coronary vasoconstriction in a dog model of unstable angina. Clin Sci (Lond) 2001; 100:405-10. [PMID: 11256979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
We investigated the effect of thrombosis in one coronary artery upon the vascular resistance of another coronary artery. In previous investigations, using an animal model of unstable angina, we have observed increased resistance downstream from thrombus within a left circumflex coronary artery (LCx) stenosis and vasoconstriction of collateral vessels from the left anterior descending artery (LAD) supplying the distal LCx vascular bed. In the present paper, we induced thrombosis within a stenosis of the LCx of 16 beagle dogs, and observed the changes in blood flow to the myocardium supplied by the LAD using the radioactive microsphere technique. This blood flow decreased with thrombosis (P = 0.005) in these animals, whereas it did not do so in three time-control experiments. The pressures across the coronary vascular bed, i.e. arterial pressure to coronary venous pressure (coronary sinus catheter), did not change. Thus the vascular resistance of the LAD bed increased significantly from 147 +/- ll.5 mmHg/ml/sec/g of tissue to 172 +/- 13.4 mmHg/ml/sec/g of tissue (P = 0.02). As the LAD territory is not perfused with blood from the artery containing thrombus, we conclude that the effect observed is caused either by release of vasoconstrictors from the thrombus into the general circulation, or by activation of a neural reflex vasoconstriction. The study suggests that unstable angina involving thrombosis in one coronary artery is a global coronary vascular disease.
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Affiliation(s)
- M Mansaray
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK
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Mansaray M, Belcher PR, Vergroesen I, Wright ZM, Hynd JW, Drake-Holland AJ, Noble MI. Downstream resistance effects of intracoronary thrombosis in the stenosed canine coronary artery. Cardiovasc Res 1999; 42:193-200. [PMID: 10435010 DOI: 10.1016/s0008-6363(98)00270-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The presence is well established in unstable angina of intracoronary thrombosis in a stenosed epicardial coronary artery. The effects of the thrombus formation on the distal microcirculation are however still unclear. METHODS We adapted the Folts canine model of left circumflex coronary arterial stenosis and intracoronary thrombosis by the insertion of a pressure catheter distal to the stenosis and by the use of 15 microns radioactive microspheres for measurement of regional myocardial blood flow. This permitted measurement during circumflex artery occlusion of collateral flow, downstream vascular resistance and collateral resistance. RESULTS Distal circumflex resistance, obtained by dividing the distal circumflex coronary pressure gradient by the collateral flow, significantly increased with thrombosis (94.47 +/- 35.72 to 120.06 +/- 34.47; p = 0.0018) mmHg/ml/min/g. Changes in collateral flow and resistance in the presence of thrombosis, during maximum ischaemic vasodilatation, were inconsistent. CONCLUSION Thrombosis causes increased vascular resistance in the microcirculation distal to the site of injury. This may be of clinical relevance in unstable angina, characterised by episodes of thrombus growth and embolization, in which ischaemic episodes may be worsened by generalised downstream vascular changes.
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Affiliation(s)
- M Mansaray
- National Heart and Lung Institute, Imperial College School of Medicine, Charing Cross Hospital, London, UK.
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