ABSTRACT
Ophthalmic manifestations and tissue tropism of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported in association with coronavirus disease 2019 (COVID-19), but the pathology and cellular localization of SARS-CoV-2 are not well characterized. The objective of this study was to evaluate macroscopic and microscopic changes and investigate cellular localization of SARS-CoV-2 across ocular tissues at autopsy. Ocular tissues were obtained from 25 patients with COVID-19 at autopsy. SARS-CoV-2 nucleocapsid gene RNA was previously quantified by droplet digital PCR from one eye. Herein, contralateral eyes from 21 patients were fixed in formalin and subject to histopathologic examination. Sections of the droplet digital PCR-positive eyes from four other patients were evaluated by in situ hybridization to determine the cellular localization of SARS-CoV-2 spike gene RNA. Histopathologic abnormalities, including cytoid bodies, vascular changes, and retinal edema, with minimal or no inflammation in ocular tissues were observed in all 21 cases evaluated. In situ hybridization localized SARS-CoV-2 RNA to neuronal cells of the retinal inner and outer layers, ganglion cells, corneal epithelia, scleral fibroblasts, and oligodendrocytes of the optic nerve. In conclusion, a range of common histopathologic alterations were identified within ocular tissue, and SARS-CoV-2 RNA was localized to multiple cell types. Further studies will be required to determine whether the alterations observed were caused by SARS-CoV-2 infection, the host immune response, and/or preexisting comorbidities.
ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) systemic symptoms and sequelae have been studied extensively, but less is known about the characterization, duration, and long-term sequelae of ocular symptoms associated with COVID-19 infection. The purpose of this study was to analyze the frequency, spectrum, and duration of ocular symptoms in participants with COVID-19 infection treated in inpatient and outpatient settings. METHODS: A retrospective electronic survey was distributed to NIH employees and the public who reported testing positive for SARS-CoV-2. The anonymous survey collected information on demographics, past ocular history, systemic COVID-19 symptoms, and ocular symptoms. RESULTS: A total of 229 (21.9% male and 78.1% female, mean age 42.5 ± 13.9) survey responses were included. Ocular symptoms were reported by 165 participants with a mean of 2.31 ± 2.42 symptoms. The most commonly reported ocular symptoms were light sensitivity (31.0%), itchy eyes (24.9%), tearing (24.9%), eye redness (24.5%), and eye pain (24.5%). Participants with ocular symptoms had a higher number of systemic symptoms compared to participants without ocular symptoms (mean 9.17 ± 4.19 vs 6.22 ± 3.63; OR: 1.21; 95% CI: 1.11 - 1.32; p < 0.001). Ocular symptoms were more common in those who reported a past ocular history compared to those who did not (81.8% vs 67.1%; OR: 2.17; 95% CI: 1.08 - 4.37; p = 0.03). Additionally, the onset of ocular symptoms occurred most frequently at the same time as systemic symptoms (47.5%), and 21.8% reported symptoms lasting ≥ 14 days. CONCLUSIONS: Ocular surface-related symptoms are the most frequent ocular manifestations, and systemic disease severity is associated with the presence of ocular symptoms. Additionally, our results show that ocular symptoms can persist post-COVID-19 infection. Further work is needed to better understand ocular symptoms in COVID-19 and long-term sequelae.
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Purpose : To systematically investigate ocular changes in autopsied eyes from fatal cases of Coronavirus disease 2019 (COVID-19) and to investigate the localization of severe acute respiratory syndrome coronavirus (SARS-CoV-2) within ocular structures. Methods : Macroscopic and microscopic histopathological evaluation was performed and the localization of SARS-CoV-2 RNA within ocular tissues investigated using an in situ hybridization (ISH) technique in 13 eyes. Contralateral eyes were freshly dissected, and droplet digital polymerase chain reaction (ddPCR) assay was performed on ocular fluids and tissues to quantify SARS-CoV-2 RNA. Results : A total of 21 fatal COVID-19 cases were included (mean age, 60.2 years [range, 27- 91 years];23.8% female). Histopathological abnormalities include vascular changes (61.9%), cytoid bodies (52.4%), and retinal edema (23.8%) with minimal inflammation (0.09%) were observed. Non-CMV viral inclusions were identified in one eye. No CMV positivity was detected. Of the 21 contralateral eyes tested by ddPCR, 14 tested positive for SARS-CoV-2. Using ddPCR and ISH, SARS-CoV-2 localization was observed in the following ocular tissues and fluid: cornea (27.3%), aqueous (26.3%), lens (54.5%), vitreous (15.0%), retina (22.2%), choroid/sclera (47.4%), and optic nerve (50.0%). The choroid/sclera, optic nerve and lens were the most frequent ocular structures found to be ddPCR positive. Evidence of replication was detected in four cases. Conclusions : Our results suggest that SARS-CoV-2 localizes to intraocular tissues. However, histological changes observed are likely a secondary hemodynamic change rather than primary effect of the virus.
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Objectives: The worldwide outbreak of coronavirus 2019 (COVID-19) has had broad consequences for individuals and societies. The pandemic has had a particular effect on nurses' mental health, as well as their social and occupational life. The aim of this study was to evaluate and compare the psychological resilience, job satisfaction, and fear levels of nurses who had and had not developed COVID-19. Methods: This cross-sectional study was conducted in a university hospital in Turkey with data collected between March 2021 and April 2021. A total of 66 nurses infected with the virus that causes COVID-19 were included in 1 group and 66 nurses who had not been infected were included in a second group. A personal information form, the Psychological Resilience Scale (PRS), the Job Satisfaction Scale (JSS), and the Fear of COVID-19 Scale (FCV-19S) were used to gather the study data. Data analysis was performed using descriptive analysis, Student’s t-test, chi-squared testing, Pearson’s correlation coefficient measurement, and one-way analysis of variance. Results: The mean PRS of the nurses was 58.44±10.12, the mean JSS score was 66.19±12.81, and the mean FCV-19S score was 18.46±6.56. COVID-19 infection did not result in a significant difference in these variables (p>.05). However, the professional satisfaction levels of the nurses who had to be hospitalized for COVID-19 treatment were lower than that of the others (p=.009) and their fear levels were higher (p=.004). Conclusion: The findings of the study indicated that while the psychological resilience, job satisfaction and fear levels of nurses who were infected with the COVID-19 virus and those who were not were not high, the infection did not result in a significant difference between the groups. Nurses who had been hospitalized for COVID-19 treatment demonstrated lower levels of professional satisfaction and higher levels of fear. Appropriate measures should be taken to increase nurses' psychological resilience and professional satisfaction. © 2021 by Journal of Psychiatric Nursing-.
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Purpose : The COVID-19 pandemic has caused significant disturbances as stay-at-home restrictions have prevented adequate healthcare delivery. This investigation aimed to assess the pandemic's impact on the incidence of ophthalmic-related procedures compared to the pre-pandemic period. Methods : TriNetX (Cambridge, MA, USA) is a real-time, federated healthcare database that was used in this retrospective review. At the time of the study, the database included 60 million unique electronic medical records (EMR) of patients from 41 healthcare organizations (HCOs) across the US. The goal of this study was to analyze the incidence of new ophthalmic procedures that were performed during a period of the COVID-19 pandemic from April 1, 2020 - September 30, 2020. April 2020 was used as the start date as this was the first full month when national lockdown measures were implemented in the USA. Similar incidence data was also extracted from the corresponding time frame of April to July in 2018 and 2019. The 2020 data was then compared to a pooled 2018-2019 data of the same time period through descriptive analyses and an independent samples ttest. Results : The incidence between fourteen types of ophthalmic procedures experienced a statistically significant reduction between April 1 to September 30, 2020 when compared to overlapping months in 2018 and 2019. Thirteen of the fourteen procedures saw at least a 32.0% decrease in incidence. These procedures included: Keratorefractive surgery (-60.3% change, p<0.001), keratoplasty (-58.4% change, p<0.001), cataract surgery (-50.5% change, p<0.001), pterygium (-49.0% change, p<0.001), oculoplastic (-47.7% change, p<0.001), YAG capsulotomy (-44.3% change, p<0.001), strabismus (-43.2% change, p=0.004), laser trabeculoplasty (-40.1% change, p<0.001), retina surgery (-38.5% change, p<0.001), glaucoma (-36.1% change, p<0.001), panretinal laser photocoagulation (-33.9% change, p<0.001), and intravitreal injection (-32.0% change, p<0.001). The incidence of global trauma during the COVID-19 pandemic was similar to identical months in 2018- 2019. Conclusions : The significant reduction in ophthalmic procedures during the COVID-19 pandemic suggests that patients are delaying ophthalmic care in the US. Further research is necessary to determine the future implications of this disruption in the care of ophthalmic patients during the COVID-19 pandemic.
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Purpose : Ocular findings have been reported in association with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite these reports, less is known on the frequency, spectrum and duration of associated ocular symptoms and their onset in the disease course. The purpose of this study is to systematically characterize ocular symptoms in participants with COVID-19 infection. Methods : An online Research Electronic Data Capture (REDCap) survey designed to characterize ocular symptoms was developed and the study information distributed to NIH employees who had tested positive for SARS-CoV-19.The survey was also advertised to the public through social media and patient recruitment mailing lists. All responses were anonymous, and participants were asked to consent to completing the survey, confirm a positive SARS-CoV PCR test and that they were 18 years of age or older. This study was approved as exempt by the National Institutes of Health (NIH) Office of IRB Operations. Results : Following exclusion of ineligible participants and incomplete responses, 181 (20.4% male and 79.0% female) complete survey responses were included for analysis including from hospitalized (9.9%) and non-hospitalized (90.1%) respondents as well NIH employees (27.1%). Ocular symptoms were reported by 77.9% of participants (mean number of ocular symptoms per participant: 2.19+/- 2.36). The most commonly reported ocular symptoms were light sensitivity 28.1%, itchy eyes (26.0%), tearing (25.4%), eye redness (24.9%), mucous discharge (20.1%), foreign body sensation (17.1%), and new onset floaters (15.4%). With the exception of itchy eyes, no significant differences in eye symptoms were found between age groups. The onset of ocular symptoms occurred mostly frequently at the same time as systemic symptoms (53.8%) compared to before (18.9%) and after systemic symptoms (27.3%). Notably, 10.6% of respondents with ocular symptoms sought medical attention by an eye care professional and 21.2% reported eye symptoms lasting ≥14 days. Conclusions : Our results show that the majority of survey respondents experienced ocular symptoms though only a minority required ophthalmic examination and our study is likely biased towards respondents with eye symptoms. Consistent with other reports, ocular surface related symptoms were more common and vision affecting symptoms were rare. Further work is needed to identify the sequalae of ocular symptoms associated with SARS-COV-2.