Kuo Irene C, Mostafa Heba H
Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, USA.
Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, USA.
Am J Ophthalmol Case Rep. 2021 Jun;22:101074. doi: 10.1016/j.ajoc.2021.101074. Epub 2021 Mar 16.
To report a case of a patient presenting with unilateral keratouveitis associated with ocular hypertension six weeks after being discharged from the hospital for COVID-19. Ocular specimens were obtained for testing.
A 69-year-old African American woman developed poor vision while hospitalized for COVID-19 in April but did not seek ophthalmic care until end of May. She had an edematous cornea, stromal keratitis, and highly elevated intraocular pressure by June. After lack of response to oral valacyclovir, aqueous fluid and swabs of her conjunctiva and limbal epithelium with corneal epithelium anterior to the limbus were sent for real-time polymerase chain reaction (PCR) for herpes simplex virus, herpes zoster virus, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epithelium from the cornea and limbus was positive for SARS-CoV-2 by PCR; specimens from the other two ocular sites were negative. All specimens were negative for herpes simplex virus and varicella zoster virus. The patient refused further treatment despite intraocular pressure above 50 mm Hg at last follow-up.
Although SARS-CoV-2 and severe acute respiratory syndrome coronavirus (SARS-CoV) have been detected by PCR in the conjunctiva and tears of patients with acute respiratory infection, presence in corneal tissue has not been described. In addition, no one has studied whether ocular tissues in convalesced patients can harbor viral RNA. Here we describe unilateral keratouveitis in a convalesced patient whose corneal epithelium/limbal tissue was positive for SARS-CoV-2 by PCR. Further investigation is required to determine whether active viral replication or viral remnants account for this result.
报告1例新冠肺炎出院6周后出现单侧角膜葡萄膜炎并伴有高眼压的患者。采集眼部标本进行检测。
一名69岁非裔美国女性在4月份因新冠肺炎住院期间视力下降，但直到5月底才寻求眼科治疗。到6月时，她出现角膜水肿、基质性角膜炎和眼压大幅升高。口服伐昔洛韦治疗无效后，采集房水以及结膜和角膜缘上皮（角膜缘前方角膜上皮）拭子，进行单纯疱疹病毒、带状疱疹病毒和严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的实时聚合酶链反应（PCR）检测。角膜和角膜缘上皮的PCR检测结果显示SARS-CoV-2呈阳性；其他两个眼部部位的标本呈阴性。所有标本的单纯疱疹病毒和水痘带状疱疹病毒检测均为阴性。尽管在最后一次随访时眼压高于50 mmHg，但患者拒绝进一步治疗。
虽然在急性呼吸道感染患者的结膜和泪液中通过PCR检测到了SARS-CoV-2和严重急性呼吸综合征冠状病毒（SARS-CoV），但尚未见在角膜组织中存在的报道。此外，也没有人研究过康复患者的眼部组织是否会携带病毒RNA。在此，我们描述了1例康复患者出现单侧角膜葡萄膜炎，其角膜上皮/角膜缘组织的PCR检测显示SARS-CoV-2呈阳性。需要进一步研究以确定是活跃的病毒复制还是病毒残余导致了这一结果。
