Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Institute of Forensic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
JAMA Ophthalmol. 2021 Apr 1;139(4):383-388. doi: 10.1001/jamaophthalmol.2020.6339.
Current recommendations are to avoid tissue for corneal transplant from donors with coronavirus disease 2019 (COVID-19) or those who were recently exposed to COVID-19 owing to the lack of knowledge about the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in corneal tissues. Evidence of SARS-CoV-2 in corneal tissue would seem to have clinical relevance for corneal transplant.
To investigate the presence of viral SARS-CoV-2 RNA in corneal discs of deceased patients with confirmed COVID-19 and assess viral genomic and subgenomic RNA load, possible infectivity, and histologic abnormalities.
DESIGN, SETTING, AND PARTICIPANTS: A case series was conducted of 11 deceased patients with COVID-19 who underwent autopsy between March 20 and May 14, 2020. Eleven corneal discs (1 corneal disc per patient) were harvested for molecular detection of viral genomic and subgenomic RNA, virus isolation, and immunohistochemistry. The SARS-CoV-2 RNA loads were compared with RNA loads in the conjunctival and throat swab samples and aqueous humor, vitreous humor, and blood samples.
Evidence of SARS-CoV-2 RNA in human corneas.
This study comprised 11 patients (6 women [55%]; mean [SD] age, 68.5 [18.8] years). In 6 of 11 eyes (55%), SARS-CoV-2 genomic RNA was detected in the cornea; subgenomic RNA was present in 4 of these 6 eyes (67%). Infectivity or the presence of viral structural proteins could not be confirmed in any eye. However, patients whose corneal disc was positive for SARS-CoV-2 RNA also had positive results for SARS-CoV-2 RNA in 4 of 6 conjunctival swab samples, 1 of 3 aqueous humor samples, 3 of 5 vitreous humor samples, and 4 of 5 blood samples. Overall, conjunctival swab samples had positive results for SARS-CoV-2 RNA in 5 of 11 cases. Postmortem SARS-CoV-2 viremia was detected in 5 of 9 patients.
Viral genomic and subgenomic RNA of SARS-CoV-2 was detected in the cornea of patients with COVID-19 viremia. The risk of COVID-19 infection via corneal transplant is low even in donors with SARS-CoV-2 viremia, but further research is necessary to assess the rate of SARS-CoV-2 transmission via corneal transplant.
由于对冠状病毒病 2019（COVID-19）患者或最近接触过 COVID-19 的供体角膜组织中存在严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的了解有限，目前的建议是避免从这些供体获取角膜用于移植。SARS-CoV-2 存在于角膜组织中，这似乎与角膜移植具有临床相关性。
调查确诊 COVID-19 死亡患者的角膜组织中是否存在病毒 SARS-CoV-2 RNA，并评估病毒基因组和亚基因组 RNA 载量、可能的传染性和组织学异常。
设计、地点和参与者：对 2020 年 3 月 20 日至 5 月 14 日期间进行尸检的 11 例 COVID-19 死亡患者进行了一项病例系列研究。采集了 11 个角膜（每个患者 1 个角膜），用于检测病毒基因组和亚基因组 RNA、病毒分离和免疫组织化学。将 SARS-CoV-2 RNA 载量与结膜和咽喉拭子样本以及房水、玻璃体液和血液样本中的 RNA 载量进行比较。
人角膜中存在 SARS-CoV-2 RNA 的证据。
这项研究包括 11 例患者（6 例女性[55%]；平均[标准差]年龄为 68.5[18.8]岁）。在 11 只眼中的 6 只（55%）中检测到 SARS-CoV-2 基因组 RNA；在这 6 只眼中的 4 只（67%）中存在亚基因组 RNA。在任何一只眼睛中均未确认传染性或病毒结构蛋白的存在。然而，角膜盘上 SARS-CoV-2 RNA 检测呈阳性的患者，其 6 例结膜拭子样本中的 4 例、3 例房水样本中的 1 例、5 例玻璃体液样本中的 3 例和 5 例血液样本中的 4 例 SARS-CoV-2 RNA 检测也呈阳性。总体而言，11 例中有 5 例结膜拭子样本 SARS-CoV-2 RNA 检测呈阳性。9 例患者中有 5 例检测到 COVID-19 病毒血症后的 SARS-CoV-2 血症。
在 COVID-19 病毒血症患者的角膜中检测到 SARS-CoV-2 的基因组和亚基因组 RNA。即使在 SARS-CoV-2 病毒血症的供体中，COVID-19 经角膜移植感染的风险也很低，但仍需要进一步研究来评估 SARS-CoV-2 通过角膜移植传播的比率。
