Kombine fako-vitrektomi ameliyatı geçiren hastalarda aköz hümör ve vitreusta SARS-CoV-2 varlığının değerlendirilmesi

Yıl 2023, , 376 - 382, 01.07.2023

Göksu Hande Naz Şimdivar , Emine Çiloğlu , Tuğba İncekalan , Neşe Çetin Doğan , Nevzat Ünal , Hivda Ülbegi Polat , Esin Akçael

https://doi.org/10.31362/patd.1232525

Öz

Amaç: Coronavirus 2019 (COVID-19) pandemisi döneminde elektif kombine katarakt ve pars plana vitrektomi cerrahisi uygulanan hastaların aköz ve vitreus sıvısında virus varlığının araştırılması amaçlandı.
Gereç ve yöntem: Bu prospektif kesitsel çalışmaya elektif kombine katarakt ve pars plana vitrektomi ameliyatı yapılacak hastalardan preoperatif 24-72 saat önceki SARS-CoV-2 nazal sürüntü testi negatif çıkan, COVID-19 bakımından asemptomatik olanlar dahil edildi. Preoperatif 24-72 saat önce alınan kan numunelerinde SARS-CoV-2 IgG antikoru değerlendirildi. Katarakt cerrahisinin başlangıcında 0.1 cc aköz hümör, vitrektominin başlangıcında ise 0.1 cc vitreus sıvısı aspire edildi. SARS-CoV-2 viral ribonucleic acid (RNA) varlığı real-time reverse transcriptase polymerase chain reaction (RT-PCR) ile değerlendirildi.
Bulgular: Otuz dokuzu erkek (%59,1), 27’si kadın (%40,9) olmak üzere 66 katılımcının göz içi sıvı örnekleri başarıyla analiz edildi. 25 hastada (%37,8) operasyondan 20 gün-60 gün önce (ortalama 49 gün) COVID-19 geçirme öyküsü mevcuttu. Operasyondan önce aşı öyküsü bulunan 58 hasta (%87,9), aşı öyküsü bulunmayan 8 hasta (%12,1) mevcut idi. Hiçbir hastanın aköz hümör ve vitreus örneklerinde SARS‑CoV‑2 RNA’sına rastlanmadı. Daha önce COVID-19 aşısı yapılmamış ve bilinen COVID-19 geçirme öyküsü olmayan 3 hastada SARSCoV-2’ye karşı gelişen IgG tespit edildi.
Sonuç: Bu çalışmada COVID-19 bakımından asemptomatik, nazal sürüntü testi negatif katılımcıların aköz ve vitreus sıvılarında SARS-CoV-2 viral genetik materyaline rastlamadık. Virüsün göz gibi immün ayrıcalıklı alanlarda latent kalma durumunu, dolaşımdan çekilse bile gözde ne kadar süre kaldığını ve nekahat döneminde neden olabileceği olası göz hastalıklarını araştıran daha kapsamlı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Aköz hümor, COVID-19, SARS-CoV-2, vitreous

Evaluation of the presence of SARS-CoV-2 in the aqueous humor and vitreous in patients undergoing combined phaco-vitrectomy surgery

Öz

Purpose: To investigate the presence of virus in the aqueous humor and vitreous of patients undergoing elective combined cataract and pars plana vitrectomy during the Coronavirus disease 2019 (COVID-19) pandemic.
Materials and methods: In this prospective cross-sectional study, of the patients to undergo elective surgery, those who had a negative severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2) nasal swab test 24-72 hours prior to the surgery and who were asymptomatic were included. SARS-CoV-2 IgG antibodies were evaluated in blood samples taken 24-72 hours before the operation. 0.1 cc of aqueous humor and 0.1 cc of vitreous fluid were aspirated at the beginning of the surgery. The presence of SARS-CoV-2 viral ribonucleic acid (RNA) was evaluated by real-time reverse transcriptase polymerase chain reaction (RT-PCR).
Results: Of 66 participants, 39 were male (59.1%) while 27 were female (40.9%). Twenty-five patients (37.8%) had a history of COVID-19 between 20 days-60 days (mean 49 days) before the surgery. There were 58 patients (87.9%) with a history of vaccination before the operation and 8 patients (12.1%) without a history of vaccination. No SARS CoV 2 RNA was detected in the aqueous humor and vitreous samples of any patient. IgG against SARSCoV-2 was detected in 3 patients who had not been vaccinated against COVID-19 before and had no known history of COVID-19.
Conclusion: We did not find any SARS-CoV-2 viral genetic material in the aqueous and vitreous fluids of asymptomatic participants whose nasal swab test results were negative, even if they recently had COVID-19. There is a need for more comprehensive studies investigating the latency of the virus in immune-privileged areas such as the eye, how long it remains in the eye even if it is withdrawn from the circulation, and possible eye diseases that it may cause during the convalescence period.

Anahtar Kelimeler

Aqueous humor, COVID-19, SARS-CoV-2, vitreous

Kaynakça

• 1. Sen S, Kannan NB, Kumar J, et al. Retinal manifestations in patients with SARS-CoV-2 infection and pathogenetic implications: a systematic review. Int Ophthalmol 2022;42:323-336. https://doi.org/10.1007/s10792-021-01996-7
• 2. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020;77:683-690. https://doi.org/10.1001/jamaneurol.2020.1127
• 3. Al Namaeh M. Ocular manifestations of COVID-19. Ther Adv Ophthalmol 2022;14:25158414221083374. https://doi.org/10.1177/25158414221083374
• 4. Varkey JB, Shantha JG, Crozier I, et al. Persistence of Ebola virus in ocular fluid during convalescence. N Engl J Med 2015;372:2423 2427. https://doi.org/10.1056/NEJMoa1500306
• 5. Gonzales JA, Hinterwirth A, Shantha J, et al. Association of ocular inflammation and rubella virus persistence. JAMA Ophthalmol 2019;137:435 438. https://doi.org/10.1001/jamaophthalmol.2018.6185
• 6. Koo EH, Eghrari AO, Dzhaber D, et al. Presence of SARS-CoV-2 Viral RNA in aqueous humor of asymptomatic individuals. Am J Ophthalmol 2021;230:151-155. https://doi.org/10.1016/j.ajo.2021.05.008
• 7. Wilfinger WW, Mackey K, Chomczynski P. Effect of pH and ionic strength on the spectrophotometric assessment of nucleic acid purity. Biotechniques 1997;22:474-481. https://doi.org/10.2144/97223st01
• 8. Division of Viral Diseases. 2019-novel coronavirus (2019-nCoV) real-time rRT-PCR panel primers and probes. Centers for Disease Control and Prevention, Atlanta, GA 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/downloads/rt-pcr-panel-primer-probes.pdf. Accessed November 14, 2022
• 9. Sen M, Honavar SG, Sharma N, Sachdev MS. COVID-19 and Eye: a review of ophthalmic manifestations of COVID-19. Indian J Ophthalmol 2021;69:488-509. https://doi.org/10.4103/ijo.IJO_297_21
• 10. Shaikh N, Al Mahdi H, Pai A, et al. Ocular manifestations of COVID-19: facts and figures from a tertiary care center. Ann Med 2022;54:310-313. https://doi.org/10.1080/07853890.2022.2029554
• 11. Bertoli F, Veritti D, Danese C, et al. Ocular Findings in COVID-19 patients: a review of direct manifestations and ındirect effects on the eye. J Ophthalmol 2020;2020:4827304. https://doi.org/10.1155/2020/4827304
• 12. Chen L, Liu M, Zhang Z, et al. Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol 2020;104:748-751. https://doi.org/10.1136/bjophthalmol-2020-316304
• 13. Holappa M, Vapaatalo H, Vaajanen A. Many faces of renin-angiotensin system - focus on eye. Open Ophthalmol J 2017;11:122-142. https://doi.org/10.2174/1874364101711010122
• 14. Chin AWH, Chu JTS, Perera MRA, et al. Stability of SARS-CoV-2 in different environmental conditions. Lancet Microbe 2020;1:10. https://doi.org/10.1016/S2666-5247(20)30003-3
• 15. List W, Regitnig P, Kashofer K, et al. Occurrence of SARS-CoV-2 in the intraocular milieu. Exp Eye Res 2021;201:108273. https://doi.org/10.1016/j.exer.2020.108273
• 16. Bayyoud T, Iftner A, Iftner T, et al. Severe acute respiratory Syndrome-Coronavirus-2: can it be detected in the retina? PLoS One 2021;16:e0251682. https://doi.org/10.1371/journal.pone.0251682
• 17. Kamalipour A, Ashraf MA, Moghimi S, et al. Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA in the Human Eye. Ocul Immunol Inflamm 2021;12:1-7. https://doi.org/10.1080/09273948.2021.1980810
• 18. Sanjay S, Anandula VR, Mahendradas P, Kawali A, Shetty R. Severe acute respiratory syndrome Corona virus and intraocular fluid sampling. Indian J Ophthalmol 2021;69:3791. https://doi.org/10.4103/ijo.IJO_2298_21
• 19. Hada M, Khilnani K, Vyas N, et al. Evaluating the presence of SARS-CoV-2 in the intraocular fluid of COVID-19 patients. Indian J Ophthalmol 2021;69:2503-2506. https://doi.org/10.4103/ijo.IJO_820_21
• 20. Yan Y, Diao B, Liu Y, Zhang W, Wang G, Chen X. Severe acute respiratory syndrome coronavirus 2 nucleocapsid protein in the ocular tissues of a patient previously ınfected with coronavirus disease 2019. JAMA Ophthalmol 2020;138:1201-1204. https://doi.org/10.1001/jamaophthalmol.2020.3962
• 21. Jin SX, Juthani VV. Acute corneal endothelial graft rejection with coinciding COVID-19 Infection. Cornea 2021;40:123-124. https://doi.org/10.1097/ICO.0000000000002556
• 22. 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;128:494-503. https://doi.org/10.1016/j.ophtha.2020.08.029