Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 1;139(4):383-388.
doi: 10.1001/jamaophthalmol.2020.6339.

Presence of SARS-CoV-2 RNA in the Cornea of Viremic Patients With COVID-19

Maria Casagrande  1 , Antonia Fitzek  2 , Martin S Spitzer  1 , Klaus Püschel  2 , Markus Glatzel  3 , Susanne Krasemann  3 , Dominik Nörz  4 , Marc Lütgehetmann  4 , Susanne Pfefferle  4 , Maximilian Schultheiss  1
Affiliations

Presence of SARS-CoV-2 RNA in the Cornea of Viremic Patients With COVID-19

Maria Casagrande et al. JAMA Ophthalmol. .

Abstract

Importance: 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.

Objectives: 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.

Main outcomes and measures: Evidence of SARS-CoV-2 RNA in human corneas.

Results: 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.

Conclusions and relevance: 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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Spitzer reported receving grants from Novartis, IDxDR, and Boehringer Ingelheim and personal fees from Bayer, Oxurion, Roche, Allergan, Alcon, Neurogene, and GSK outside the submitted work. Dr Glatzel reported receiving grants from the German Federal Ministry of Education and Research (DEFEAT PANDEMics) during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA
SARS-CoV-2 RNA loads in eye samples, blood samples, and throat swab samples are displayed for each patient. The darkness of the fields indicates the viral load; darker color indicates higher viral load (see color bar on the right side), and white boxes with an X indicate missing values.
See this image and copyright information in PMC

Comment in

References

    1. Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. J Virol. 2020;94(7):e00127-20. doi:10.1128/JVI.00127-20 - DOI - PMC - PubMed
    1. Hoffmann M, Kleine-Weber H, Schroeder S, et al. . SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271-280. doi:10.1016/j.cell.2020.02.052 - DOI - PMC - PubMed
    1. Sungnak W, Huang N, Bécavin C, et al. ; HCA Lung Biological Network . SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes. Nat Med. 2020;26(5):681-687. doi:10.1038/s41591-020-0868-6 - DOI - PMC - PubMed
    1. Bayyoud T, Iftner A, Iftner T, et al. . Absence of severe acute respiratory syndrome-coronavirus-2 RNA in human corneal tissues. Cornea. Published online June 29, 2020. doi:10.1097/ICO.0000000000002479 - DOI - PMC - PubMed
    1. Gain P, Jullienne R, He Z, et al. . Global survey of corneal transplantation and eye banking. JAMA Ophthalmol. 2016;134(2):167-173. doi:10.1001/jamaophthalmol.2015.4776 - DOI - PubMed