Presence of SARS-CoV-2 Viral RNA in Aqueous Humor of Asymptomatic Individuals

Abstract

\n Purpose\n : To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is detectable in the aqueous of asymptomatic individuals presenting for ophthalmic surgery.\n \n Design\n : Prospective cross-sectional study.\n \n Methods\n : Setting and Participants, All patients undergoing anterior segment surgery at an Ambulatory Surgical Center (ASC) belonging to a tertiary academic center in South Florida during a 102-day period between June and September 2020 received nasal swab testing for SARS-CoV-2 and underwent a relevant review of symptoms prior to surgery, with negative results required for both in order to proceed with surgery.\n Main Outcomes and Measures, A small sample of aqueous humor (approximately 0.2cc) was acquired at the beginning of anterior segment surgery in all participants. Aqueous humor was analyzed for SARS-CoV-2 viral ribonucleic acid (RNA) using real-time reverse transcriptase polymerase chain reaction (rRT-PCR). Demographic information was acquired from participants for secondary analyses.\n \n Results\n : A total of 70 samples were acquired. Of these, 39 were excluded due to insufficient material or inconclusive results. Out of 31 samples that were successfully analyzed, 6 (19.4%) demonstrated detectable SARS-CoV-2 RNA. None of the six individuals (0%) with detectable viral RNA in aqueous humor reported symptoms during the year, compared to 2 of 25 individuals (8%) with negative samples (p=1). Positive samples were distributed throughout the study period, including both the first and the last day of enrollment.\n \n Conclusion\n : The presence of SARS-CoV-2 viral RNA in aqueous despite negative nasal swab testing confirms its presence beyond the blood-ocular barrier in asymptomatic individuals and raises the possibility that the virus may persist in immunoprivileged spaces despite an absence of symptoms.\n