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Severe Acute Respiratory Syndrome Coronavirus 2 Nucleocapsid Protein in the Ocular Tissues of a Patient Previously Infected With Coronavirus Disease 2019

Educational Objective
To understand how to detect SARS-CoV-2 in ocular tissues of patients with COVID-19
1 Credit CME
Key Points

Question  Does severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) exist in the ocular tissues of a patient with coronavirus disease 2019 (COVID-19)?

Findings  In this case study, nucleocapsid protein antigens were detected on the cells of the conjunctiva, iris, and trabecular meshwork of a patient with a COVID-19 infection, and these antigens were absent on the specimens from the control patient. In addition, angiotensin-converting enzyme 2 receptor proteins were detected in the conjunctiva cells of this patient and a control participant.

Meaning  Nucleocapsid protein antigens of SARS-CoV-2 existed in the inner ocular tissues of a patient previously infected with COVID-19, which implied that SARS-CoV-2 can infect ocular tissues as well as the respiratory system.

Abstract

Importance  Coronavirus disease 2019 (COVID-19) has been recognized as a pandemic by the World Health Organization. Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can also infect tissues besides the respiratory system, such as the ocular tissues, remains unclear.

Objective  To determine whether SARS-CoV-2 exists intracellularly in the ocular tissues of a patient previously infected with COVID-19.

Design, Setting, and Participants  This case study analyzed a patient previously infected with COVID-19 who had an acute glaucoma attack during her rehabilitation. Plasma samples and tissue specimens, including ones from the conjunctiva, anterior lens capsular, trabecular meshwork, and iris, were collected during phacoemulsification and trabeculectomy surgery. Specimens from another patient who had glaucoma but not COVID-19 were used as a negative control.

Main Outcomes and Measures  Specimens were analyzed using hematoxylin-eosin staining. The nucleocapsid protein antigen of SARS-CoV-2 was measured in the conjunctiva, trabecular meshwork, and iris using immunofluorescence and immunohistochemistry. The expression of angiotensin-converting enzyme 2 receptor on the conjunctiva was measured using immunohistochemistry.

Results  The patient with a previous COVID-19 infection was female and 64 years old, and the control patient without a COVID-19 infection history was male and 61 years old. The nucleocapsid protein antigen of SARS-CoV-2 was detected on the cells of the conjunctiva, trabecular, and iris of the patient infected with COVID-19 but not in the control participant, while angiotensin-converting enzyme 2 receptor proteins were detected on the conjunctiva of both patients.

Conclusions and Relevance  The nucleocapsid protein antigen of SARS-CoV-2 existed intracellularly in the ocular tissues of a patient previously infected with COVID-19. Thus, SARS-CoV-2 can also infect ocular tissues in addition to the respiratory system.

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Article Information

Accepted for Publication: August 9, 2020.

Corresponding Author: Xiao Chen, MD, Department of Ophthalmology, General Hospital of the Central Theater Command, 627 Wuluo Rd, Wuhan 430070, China (cxfn817@163.com).

Published Online: October 8, 2020. doi:10.1001/jamaophthalmol.2020.3962

Author Contributions: Dr Chen had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Yan and Diao contributed equally to this study and are co–first authors.

Concept and design: Yan, Chen.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Yan, Diao, Liu, Wang, Chen.

Critical revision of the manuscript for important intellectual content: Diao, Liu, Zhang, Chen.

Statistical analysis: Diao.

Obtained funding: Yan.

Administrative, technical, or material support: Diao, Zhang, Wang, Chen.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank both patients for granting permission to publish this information.

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