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Penkava J, Muenchhoff M, Badell I, Osterman A, Delbridge C, Niederbuchner F, Soliman S, Rudelius M, Graf A, Krebs S, Blum H, Ulbig M, Baumann C, Zapp D, Maier M, Keppler OT, Lohmann CP, Ledderose S. Detection of SARS-CoV-2-RNA in post-mortem samples of human eyes. Graefes Arch Clin Exp Ophthalmol 2021; 260:1789-1797. [PMID: 34962592 PMCID: PMC8713040 DOI: 10.1007/s00417-021-05529-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/16/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023] Open
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.
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Affiliation(s)
- Josef Penkava
- Department of Ophthalmology, Technical University Munich, Munich, Germany.
| | - Maximilian Muenchhoff
- Max von Pettenkofer Institute & Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Irina Badell
- Max von Pettenkofer Institute & Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Andreas Osterman
- Max von Pettenkofer Institute & Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Claire Delbridge
- Department of Pathology and Neuropathology, TUM School of Medicine, Technical University Munich, Munich, Germany
| | | | - Sarah Soliman
- Department of Pathology, Ludwig-Maximilian University Munich, Munich, Germany
| | - Martina Rudelius
- Department of Pathology, Ludwig-Maximilian University Munich, Munich, Germany
| | - Alexander Graf
- Laboratory for Functional Genome Analysis, Gene Center, Ludwig-Maximilians-University, Munich, Germany
| | - Stefan Krebs
- Laboratory for Functional Genome Analysis, Gene Center, Ludwig-Maximilians-University, Munich, Germany
| | - Helmut Blum
- Laboratory for Functional Genome Analysis, Gene Center, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Ulbig
- Department of Ophthalmology, Technical University Munich, Munich, Germany
| | - Carmen Baumann
- Department of Ophthalmology, Technical University Munich, Munich, Germany
| | - Daniel Zapp
- Department of Ophthalmology, Technical University Munich, Munich, Germany
| | - Mathias Maier
- Department of Ophthalmology, Technical University Munich, Munich, Germany
| | - Oliver T Keppler
- Max von Pettenkofer Institute & Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Chris P Lohmann
- Department of Ophthalmology, Technical University Munich, Munich, Germany
| | - Stephan Ledderose
- Department of Pathology, Ludwig-Maximilian University Munich, Munich, Germany
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