Tags

Type your tag names separated by a space and hit enter

Evaluation of SARS-CoV-2 in Tears of Patients with Moderate to Severe COVID-19.
Ophthalmology. 2021 04; 128(4):494-503.O

Abstract

PURPOSE

To investigate the presence of SARS-CoV-2 RNA in tears of patients with moderate to severe coronavirus disease 2019 (COVID-19).

DESIGN

Cross-sectional study.

PARTICIPANTS

Patients with laboratory-proven moderate to severe COVID-19.

METHODS

Tears were collected within 48 hours of laboratory confirmation using 3 methods: conjunctival swab plus Schirmer's test strips (group 1), conjunctival swab (group 2), and Schirmer's test strips (group 3). Samples from both the eyes of each patient were transported in a single viral transport media for real-time RT-PCR. Detailed demographic profiles, systemic symptoms, comorbidities, and ocular manifestations were noted.

MAIN OUTCOME MEASURES

Viral load of a sample was determined using cycle threshold (Ct) value of E gene. A specimen was considered to show positive results if the amplification curve for the E gene crossed the threshold line within 35 cycles and if it showed positive results on an RNA-dependent RNA polymerase or open reading frame 1b gene assay.

RESULTS

Of the 78 patients enrolled in the study, samples from 3 patients were found to be inadequate for analysis. Thirty-six patients (48%) had moderate disease, whereas 39 patients (52%) had severe disease, with no ocular involvement in any patient. In the 75 patients, RT-PCR analysis of tears showed positive results in 18 patients (24%), and 29 of 225 samples (12.9%) showed positive results. Positive results were found in 11 (14.7%), 11 (14.7%), and 7 (9.3%) patients in groups 1, 2, and 3, respectively (P = 0.3105). Mean Ct values in groups 1, 2, and 3 were 28.36 ± 6.15, 29.00 ± 5.58, and 27.86 ± 6.46 (P = 0.92), respectively. Five patients showed positive RT-PCR results by all 3 methods (mean Ct value, 25.24 ± 6.33), and 12 patients showed positive results by any of the 3 methods (mean Ct value, 32.16 ± 1.94), the difference in Ct values being statistically significant (P = 0.029). The median value of symptomatology in patients with positive RT-PCR results from tears was 5 days (range, 4-9 days).

CONCLUSIONS

SARS-CoV-2 RNA was detected in tears of 24% of patients with laboratory-proven moderate to severe COVID-19. Conjunctival swab remains the gold standard of tear collection for RT-PCR assay. A significantly higher possibility of viral transmission exists through tears in patients with moderate to severe COVID-19.

Authors+Show Affiliations

Guru Nanak Eye Centre, Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India.Guru Nanak Eye Centre, Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India. Electronic address: gruchi1@rediffmail.com.Guru Nanak Eye Centre, Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India.Guru Nanak Eye Centre, Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India.Department of Microbiology, Maulana Azad Medical College, New Delhi, India.Department of Microbiology, Maulana Azad Medical College, New Delhi, India.Department of Microbiology, Maulana Azad Medical College, New Delhi, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32882309

Citation

Arora, Ritu, et al. "Evaluation of SARS-CoV-2 in Tears of Patients With Moderate to Severe COVID-19." Ophthalmology, vol. 128, no. 4, 2021, pp. 494-503.
Arora R, Goel R, Kumar S, et al. Evaluation of SARS-CoV-2 in Tears of Patients with Moderate to Severe COVID-19. Ophthalmology. 2021;128(4):494-503.
Arora, R., Goel, R., Kumar, S., Chhabra, M., Saxena, S., Manchanda, V., & Pumma, P. (2021). Evaluation of SARS-CoV-2 in Tears of Patients with Moderate to Severe COVID-19. Ophthalmology, 128(4), 494-503. https://doi.org/10.1016/j.ophtha.2020.08.029
Arora R, et al. Evaluation of SARS-CoV-2 in Tears of Patients With Moderate to Severe COVID-19. Ophthalmology. 2021;128(4):494-503. PubMed PMID: 32882309.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of SARS-CoV-2 in Tears of Patients with Moderate to Severe COVID-19. AU - Arora,Ritu, AU - Goel,Ruchi, AU - Kumar,Sumit, AU - Chhabra,Mohit, AU - Saxena,Sonal, AU - Manchanda,Vikas, AU - Pumma,Palak, Y1 - 2020/08/31/ PY - 2020/06/22/received PY - 2020/07/14/revised PY - 2020/08/26/accepted PY - 2020/9/4/pubmed PY - 2020/9/4/medline PY - 2020/9/4/entrez KW - COVID-19 KW - Conjunctival swab KW - Nasopharyngeal swab KW - Reverse-transcriptase polymerase chain reaction KW - SARS-CoV-2 SP - 494 EP - 503 JF - Ophthalmology JO - Ophthalmology VL - 128 IS - 4 N2 - PURPOSE: To investigate the presence of SARS-CoV-2 RNA in tears of patients with moderate to severe coronavirus disease 2019 (COVID-19). DESIGN: Cross-sectional study. PARTICIPANTS: Patients with laboratory-proven moderate to severe COVID-19. METHODS: Tears were collected within 48 hours of laboratory confirmation using 3 methods: conjunctival swab plus Schirmer's test strips (group 1), conjunctival swab (group 2), and Schirmer's test strips (group 3). Samples from both the eyes of each patient were transported in a single viral transport media for real-time RT-PCR. Detailed demographic profiles, systemic symptoms, comorbidities, and ocular manifestations were noted. MAIN OUTCOME MEASURES: Viral load of a sample was determined using cycle threshold (Ct) value of E gene. A specimen was considered to show positive results if the amplification curve for the E gene crossed the threshold line within 35 cycles and if it showed positive results on an RNA-dependent RNA polymerase or open reading frame 1b gene assay. RESULTS: Of the 78 patients enrolled in the study, samples from 3 patients were found to be inadequate for analysis. Thirty-six patients (48%) had moderate disease, whereas 39 patients (52%) had severe disease, with no ocular involvement in any patient. In the 75 patients, RT-PCR analysis of tears showed positive results in 18 patients (24%), and 29 of 225 samples (12.9%) showed positive results. Positive results were found in 11 (14.7%), 11 (14.7%), and 7 (9.3%) patients in groups 1, 2, and 3, respectively (P = 0.3105). Mean Ct values in groups 1, 2, and 3 were 28.36 ± 6.15, 29.00 ± 5.58, and 27.86 ± 6.46 (P = 0.92), respectively. Five patients showed positive RT-PCR results by all 3 methods (mean Ct value, 25.24 ± 6.33), and 12 patients showed positive results by any of the 3 methods (mean Ct value, 32.16 ± 1.94), the difference in Ct values being statistically significant (P = 0.029). The median value of symptomatology in patients with positive RT-PCR results from tears was 5 days (range, 4-9 days). CONCLUSIONS: SARS-CoV-2 RNA was detected in tears of 24% of patients with laboratory-proven moderate to severe COVID-19. Conjunctival swab remains the gold standard of tear collection for RT-PCR assay. A significantly higher possibility of viral transmission exists through tears in patients with moderate to severe COVID-19. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/32882309/Evaluation_of_SARS_CoV_2_in_Tears_of_Patients_with_Moderate_to_Severe_COVID_19_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(20)30847-2 DB - PRIME DP - Unbound Medicine ER -