key: cord-1018962-jcx1jbqu authors: Lauermann, Peer; Storch, Marcus; Weig, Michael; Tampe, Björn; Winkler, Martin; Hoerauf, Hans; Feltgen, Nicolas; Hakroush, Samy title: There is no intraocular affection on a SARS-CoV-2 - Infected ocular surface date: 2020-08-20 journal: Am J Ophthalmol Case Rep DOI: 10.1016/j.ajoc.2020.100884 sha: 76b43ac37334b49675e5448467c20d050c8b3f31 doc_id: 1018962 cord_uid: jcx1jbqu PURPOSE: The presence of SARS-CoV-2 RNA in anterior chamber fluid and/or the vitreous in patients with SARS-CoV-2 RNA on the ocular surface is unclear. Knowledge about the infectious state of intraocular structures could influence the daily work of ophthalmic surgeons. OBSERVATIONS: We analyzed ocular samples from a patient who had succumbed to COVID-19 pneumonia for the prevalence of SARS-CoV-2 RNA. We detected viral RNA in the ocular-surface samples on one swab and in one excidate from the conjunctiva. Samples from the anterior chamber and vitreous revealed no SARS-CoV-2 RNA. CONCLUSIONS: and Importance SARS-CoV-2 can effectively be inactivated with standard disinfection agents. The now proven absence of SARS-CoV-2 in intraocular fluids could influence how ophthalmic surgeons work. Without having to account for the risk of a contagion via the anterior chamber and/or vitreous body, the surgical staff would require no additional, more elaborate protection. Since the outbreak of the novel coronavirus (SARS-CoV-2), the ocular surface has been 31 suggested as a potential infection zone [1] [2] [3] [4] . Whether the virus is also detectable in deeper eye 32 tissues is not yet known. However, knowledge thereof could be particularly important for 33 ophthalmic surgeons, since aqueous and vitreous fluid could act as an infectious medium 34 while intraocular instruments are being changed, and aerosols particles containing SARS-35 CoV-2 could be dispersed. The lack of knowledge about SARS-CoV-2 RNA is present in the 36 eye's deeper compartments has already led to different protective recommendations. Various 37 professional associations have suggested wearing filtering face-piece (FFP) 3 masks and 38 protective eye wear during surgical procedures like vitrectomies to account for possible 39 aerosol production 5,6 . Below, we report on the ocular findings from a 72-year-old patient who 40 died of CoVid-19 pneumonia. 41 On April 28, 2020, a 72-year-old female patient -already intubated and ventilated -was 43 transferred from an external hospital to the intensive care unit at the University Medical 44 Center Goettingen. She died the following day of severe septic shock and multiple organ 45 failure due to CoVid-19 pneumonia. There was no documentation of eye involvement in her 46 medical records. 47 A few hours after death, samples of various eye tissues were removed from the left eye 50 during autopsy: a conjunctival swab, two conjunctival excidates, one anterior chamber fluid 51 sample and one vitreous sample (1 ml each). The conjunctival swab was taken with a Copan 52 Potential conflict of interest exists: We wish to draw the attention of the Editor to the following facts, which may be considered as potential conflicts of interest, and to significant financial contributions to this work: The nature of potential conflict of interest is described below: No conflict of interest exists. We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. Funding was received for this work. All of the sources of funding for the work described in this publication are acknowledged below: No funding was received for this work. J o u r n a l P r e -p r o o f 2 We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We further confirm that any aspect of the work covered in this manuscript that has involved human patients has been conducted with the ethical approval of all relevant bodies and that such approvals are acknowledged within the manuscript. IRB approval was obtained (required for studies and series of 3 or more cases) Written consent to publish potentially identifying information, such as details or the case and photographs, was obtained from the patient(s) or their legal guardian(s). The International Committee of Medical Journal Editors (ICMJE) recommends that authorship be based on the following four criteria: 1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND 2. Drafting the work or revising it critically for important intellectual content; AND 3. Final approval of the version to be published; AND 4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All those designated as authors should meet all four criteria for authorship, and all who meet the four criteria should be identified as authors. For more information on authorship, please see http://www.icmje.org/recommendations/browse/roles-andresponsibilities/defining-the-role-of-authors-and-contributors.html#two. All listed authors meet the ICMJE criteria. We attest that all authors contributed significantly to the creation of this manuscript, each having fulfilled criteria as established by the ICMJE. SARS-CoV-2 in the ocular surface of COVID-19 patients The Ocular Surface and the Coronavirus Disease 2019: 106 Does a Dual 'Ocular Route' Exist? SARS-CoV-2 transmission through the ocular surface must not be ignored Expression analysis of SARS-CoV-2 related ACE2 and TMPRSS2 in 110 eye tissues Vitreoretinal-surgery-management-guidance-070420 A pneumonia outbreak associated with a new coronavirus of 120 probable bat origin Protection and disinfection policies against 122 SARS-CoV-2 (COVID-19) Ultrastructural characterization of SARS coronavirus. 124 Emerging Infect Dis