Detection of SARS-CoV-2-RNA in post-mortem samples of human eyes

Josef Penkava, Maximilian Muenchhoff, Irina Badell, Andreas Osterman, Claire Delbridge, Florian Niederbuchner, Sarah Soliman, Martina Rudelius, Alexander Graf, Stefan Krebs, Helmut Blum, Michael Ulbig, Carmen Baumann, Daniel Zapp, Mathias Maier, Oliver T. Keppler, Chris P. Lohmann, Stephan Ledderose

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Purpose: To detect SARS-CoV-2 RNA in post-mortem human eyes. Ocular symptoms are common in patients with COVID-19. In some cases, they can occur before the onset of respiratory and other symptoms. Accordingly, SARS-CoV-2 RNA has been detected in conjunctival samples and tear film of patients suffering from COVID-19. However, the detection and clinical relevance of intravitreal SARS-CoV-2 RNA still remain unclear due to so far contradictory reports in the literature. Methods: In our study 20 patients with confirmed diagnosis of COVID-19 were evaluated post-mortem to assess the conjunctival and intraocular presence of SARS-CoV-2 RNA using sterile pulmonary and conjunctival swabs as well as intravitreal biopsies (IVB) via needle puncture. SARS-CoV-2 PCR and whole genome sequencing from the samples of the deceased patients were performed. Medical history and comorbidities of all subjects were recorded and analyzed for correlations with viral data. Results: SARS-CoV-2 RNA was detected in 10 conjunctival (50%) and 6 vitreal (30%) samples. SARS-CoV-2 whole genome sequencing showed the distribution of cases largely reflecting the frequency of circulating lineages in the Munich area at the time of examination with no preponderance of specific variants. Especially there was no association between the presence of SARS-CoV-2 RNA in IVBs and infection with the variant of concern (VOC) alpha. Viral load in bronchial samples correlated positively with load in conjunctiva but not the vitreous. Conclusion: SARS-CoV-2 RNA can be detected post mortem in conjunctival tissues and IVBs. This is relevant to the planning of ophthalmologic surgical procedures in COVID-19 patients, such as pars plana vitrectomy or corneal transplantation. Furthermore, not only during surgery but also in an outpatient setting it is important to emphasize the need for personal protection in order to avoid infection and spreading of SARS-CoV-2. Prospective studies are needed, especially to determine the clinical relevance of conjunctival and intravitreal SARS-CoV-2 detection concerning intraocular affection in active COVID-19 state and in post-COVID syndrome.

Original languageEnglish
Pages (from-to)1789-1797
Number of pages9
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Volume260
Issue number5
DOIs
StatePublished - May 2022

Keywords

  • COVID-19
  • Conjunctivitis
  • Intraocular involvement
  • SARS-CoV-2
  • Vitreous sample

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