Unit of Ophthalmology, Azienda Socio-Sanitaria Territoriale (ASST) dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Laboratory of Microbiology, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
JAMA Ophthalmol. 2021 Sep 1;139(9):956-963. doi: 10.1001/jamaophthalmol.2020.5464.
Since February 2020, coronavirus disease 2019 (COVID-19) has spread rapidly all over the world, with an epidemiological cluster in Lombardy, Italy. The viral communicability may be mediated by various body fluids, but insufficient information is available on the presence of the virus in human tears.
To investigate the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in tears collected from patients with COVID-19 by means of real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) assay and to assess the association of virus presence with concomitant clinical conditions.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study conducted between April 9 and May 5, 2020. The setting was intensive care units at Azienda Socio-Sanitaria Territoriale (ASST) Sette-Laghi Hospital, University of Insubria, in Varese, Lombardy, Italy. A conjunctival swab was performed in 91 patients hospitalized for COVID-19, which was clinically diagnosed by rRT-PCR assay on nasopharyngeal swabs and by radiological imaging. Conjunctival swabs from 17 additional healthy volunteer participants with no symptoms of COVID-19 were examined to evaluate the availability and applicability of the conjunctival swab test.
SARS-CoV-2 detection by means of rRT-PCR assay performed on the collected samples obtained by conjunctival swabs.
Conjunctival swab and nasopharyngeal swab results are reported, as well as demographic and clinical data.
A total of 108 participants (mean [SD] age, 58.7 [14.2] years; 55 female and 53 male) were tested for SARS-CoV-2 using rRT-PCR assay, including 91 patients hospitalized with COVID-19 and 17 were healthy volunteers. SARS-CoV-2 was found on the ocular surface in 52 of 91 patients with COVID-19 (57.1%; 95% CI, 46.3%-67.5%), with a wide variability in the mean viral load from both eyes. Among a subset of 41 patients, concordance of 63.0% (95% CI, 41.0%-81.0%) was found between positive conjunctival and nasopharyngeal swab test results when performed within 2 days of each other. In 17 of these patients, nasopharyngeal swab results were negative for SARS-CoV-2. In 10 of these 17 patients, conjunctival swab results were positive for the virus.
In this study, SARS-CoV-2 RNA was found on the ocular surface in a large part of this cohort of patients with COVID-19, although the infectivity of this material could not be determined. Because patients may have positive test results with a conjunctival swab and negative results with a nasopharyngeal swab, use of the slightly invasive conjunctival swab may be considered as a supplementary diagnostic test.
自 2020 年 2 月以来，2019 年冠状病毒病（COVID-19）已在全球迅速蔓延，意大利伦巴第大区出现了一个流行病学集群。病毒的传染性可能通过各种体液介导，但关于病毒在人泪液中的存在的信息不足。
通过实时逆转录-聚合酶链反应（rRT-PCR）检测，调查 COVID-19 患者泪液中严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的存在率，并评估病毒存在与伴随临床状况的相关性。
设计、地点和参与者：这是一项于 2020 年 4 月 9 日至 5 月 5 日进行的横断面研究。该研究地点是意大利伦巴第大区瓦雷泽市因苏布里亚大学 Azienda Socio-Sanitaria Territoriale（ASST）Sette-Laghi 医院的重症监护病房。对 91 名因 COVID-19 住院的患者进行了结膜拭子检查，这些患者的临床诊断是通过鼻咽拭子 rRT-PCR 检测和影像学检查进行的。对 17 名没有 COVID-19 症状的健康志愿者参与者的额外结膜拭子进行了检查，以评估结膜拭子检测的可用性和适用性。
通过对采集的结膜拭子样本进行 rRT-PCR 检测，检测 SARS-CoV-2。
报告了结膜拭子和鼻咽拭子的结果，以及人口统计学和临床数据。
共有 108 名参与者（平均[SD]年龄 58.7[14.2]岁；55 名女性和 53 名男性）接受了 rRT-PCR 检测，包括 91 名 COVID-19 住院患者和 17 名健康志愿者。在 91 名 COVID-19 患者中，有 52 名（57.1%；95%CI，46.3%-67.5%）在眼部表面发现了 SARS-CoV-2，从两只眼睛的平均病毒载量来看存在很大差异。在 41 名患者的亚组中，当在 2 天内彼此相邻进行时，发现结膜和鼻咽拭子检测结果之间的一致性为 63.0%（95%CI，41.0%-81.0%）。在这些患者中的 17 名中，鼻咽拭子结果为 SARS-CoV-2 阴性。在这 17 名患者中的 10 名中，结膜拭子结果为病毒阳性。
在这项研究中，尽管无法确定该材料的传染性，但在这一大群 COVID-19 患者中，在眼部表面发现了 SARS-CoV-2 RNA。由于患者可能会出现结膜拭子检测结果阳性和鼻咽拭子检测结果阴性，因此可以考虑使用这种侵入性较小的结膜拭子作为补充诊断检测。
