Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.
Catholic University "Sacro Cuore", Rome, Italy.
Eur J Ophthalmol. 2021 Nov;31(6):2886-2893. doi: 10.1177/1120672120976548. Epub 2020 Dec 23.
The possible transmission of severe acute respiratory coronavirus 2 (SARS-CoV-2) by tears and conjunctiva is still debated.
Main outcome was to investigate the agreement between nasopharyngeal swab (NPs) and conjunctival swabs (Cs) in patients with SARS-CoV-2 infection. We divided patients into four groups: (1) NPs and Cs both negative (C-NF-), (2) NPs positive and Cs negative (NFs+Cs-), (3) NPs negative and Cs positive (NFs-Cs+), and (4) NPs and Cs both positive (NFs-Cs+). The secondary outcomes were to correlate Cs results with systemic clinical parameters such as: oxygen saturation (SpO), dyspnea degree (DP), radiologic pulmonary impairment based on chest radiography (XR) or computed tomography (CT), blood chemistry as D-Dimer (D-Dimer), fibrinogen, ferritin, lactate dehydrogenase (LDH), and C-reactive protein (C-RP).
A total of 100 conjunctival swabs in 50 patients with SARS-CoV-2 have been enrolled in this interventional clinical trials. Ocular signs (conjunctivitis) were present in five patients (10%). NPs and Cs highlighted a poor level of agreement (0.025; = 0.404). Median SpO levels are the highest in the NF-C- group (98%) and the lowest (90%) in the group NF+C+ ( = 0.001). Pulmonary impairment was statistically significantly different between NFs and Cs groups ( = 0.019). Pulmonary impairment score increased from NFs-Cs- group (3.8 ± 3.9), to NFs+Cs+ group (6.7 ± 4.1). Intensive care unit patients showed higher COVID-19 Cs positivity in conjunctiva (12.5%) against hospitalized ones (5.8%).
In patients hospitalized for SARS-CoV-2 the virus can be detected in conjunctival swab. Intensive care unit patients may reveal a higher COVID-19 presence in the conjunctiva. The most severe pulmonary impairment can be observed in NFs and Cs positivity.
Clinicaltrials.gov registration.
ID number: 0013008/20.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）是否通过眼泪和结膜传播仍存在争议。
主要结局是研究 SARS-CoV-2 感染患者的鼻咽拭子（NPs）和结膜拭子（Cs）之间的一致性。我们将患者分为四组：（1）NPs 和 Cs 均为阴性（C-NF-）；（2）NPs 阳性且 Cs 阴性（NFs+Cs-）；（3）NPs 阴性且 Cs 阳性（NFs-Cs+）；（4）NPs 和 Cs 均为阳性（NFs-Cs+）。次要结局是将 Cs 结果与全身临床参数相关联，如：血氧饱和度（SpO2）、呼吸困难程度（DP）、胸部 X 线或计算机断层扫描（CT）所示的肺部放射性损伤、血液化学指标（D-二聚体（D-Dimer）、纤维蛋白原、铁蛋白、乳酸脱氢酶（LDH）和 C-反应蛋白（C-RP）。
本干预性临床试验共纳入 50 例 SARS-CoV-2 患者的 100 例结膜拭子。5 例（10%）患者出现眼部症状（结膜炎）。NPs 和 Cs 的一致性较差（0.025；=0.404）。NF-C-组的 SpO2 中位数最高（98%），NF+C+组的最低（90%）（=0.001）。NFs 和 Cs 组之间的肺部损伤程度有统计学差异（=0.019）。肺部损伤评分从 NFs-Cs-组（3.8±3.9）增加到 NFs+Cs+组（6.7±4.1）。重症监护病房患者的 COVID-19 Cs 阳性率（12.5%）高于住院患者（5.8%）。
在因 SARS-CoV-2 住院的患者中，可在结膜拭子中检测到病毒。重症监护病房患者的 COVID-19 可能在结膜中更常见。在 NFs 和 Cs 均为阳性时，可观察到最严重的肺部损伤。
Clinicaltrials.gov 注册。
注册号：0013008/20。
