Investigation of SARS-CoV-2 in Postmortem Ocular Tissues and Evaluation of Its Effects on Corneal Donation

The purpose of this study was to investigate the presence of viruses in postmortem nasopharyngeal swabs and ocular tissues of patients with coronavirus disease 19 (COVID-19) confirmed through an antemortem reverse transcription polymerase chain reaction (RT-PCR) test.

We recorded demographic data, comorbidities, treatments, and vaccination status of the patients diagnosed with COVID-19 and monitored in the intensive care unit. Nasopharyngeal swab samples were collected from the patients within 2 hours postmortem followed by swabs from both eyes, lower and upper conjunctival sacs, corneal epithelial layer, and samples from anterior chamber fluid. The geneMAP 2019-nCoV severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) detection kit was used to detect the samples showing the presence of SARS-CoV-2.

Among the 47 patients (mean age 74 years, range 39-92) included in the study, 29 were men and 18 were women. The nasopharyngeal swab samples of 21 patients were positive for the RT-PCR test for SARS-CoV-2, whereas at least one of the ocular tissue samples in 6 of those patients were positive for the RT-PCR test for SARS-CoV-2. However, all ocular swab samples were tested negative for SARS-CoV-2 in the 26 patients with negative nasopharyngeal swab samples. The mean duration from COVID-19 diagnosis to mortality was 10 days (range 2-27 days) in patients with positive postmortem nasopharyngeal swab samples for SARS-CoV-2, compared with an average of 21 days (1-80 days) in patients who tested negative. This difference was statistically significant (P = 0.01).

Cadavers with negative postmortem nasopharyngeal swab samples for SARS-CoV-2 and those with the time from diagnosis to death of >3 weeks may be considered as candidates for corneal donation.