To the Editor:
We read with interest the article by Seah et al. [1] and correspondence thereof by Yeung [2] regarding the potential dangers of COVID-19 in ophthalmologic practice. While the former highlighted the importance of human secretions like tears as a potential source of transmission of the virus, the latter explored the possibility of SARS-CoV-2 in amniotic membrane grafts.
The amniotic membrane, while having great potential for healing ophthalmologic wounds, was recently shown to be RT-PCR positive for viral RNA in two critically ill pregnant females with COVID-19 [3]. Amniotic fluid specimen too, tested RT-PCR positive in an earlier case report of possible maternal-foetal transmission [4]. While there is no confirmed data on the survival of SARS CoV-2 in cryopreserved amniotic membranes, it is clear that temperature strongly influences viral persistence (>2 weeks survival at 4 °C vs only 2 days at 20 °C) [5].
In light of these findings, we strongly suggest ophthalmologists to observe extreme caution while handling body fluids and placental membranes during the current COVID-19 pandemic. The approach of testing a pregnant female donor for the disease by throat swab RT-PCR may be augmented by placental and/or membrane PCR. Amniotic membranes cryopreserved during this period (January 2020 onwards), from asymptomatic donors must be confirmed to be free of this infection before being used to treat immunocompromised patients like those of Steven Johnson syndrome etc.
References
Seah I, Su X, Lingam G. Revisiting the dangers of the coronavirus in the ophthalmology practice. Eye (Lond). 2020;1–3. https://doi.org/10.1038/s41433-020-0790-7.
Yeung TLM, Liu S, Li BCY, Mok KM, Li KKW. Amniotic membrane harvesting during COVID-19 pandemic. Eye (Lond). 2020;1. https://doi.org/10.1038/s41433-020-0947-4.
Penfield CA, Brubaker SG, Limaye MA, Lighter J, Ratner AJ, Thomas KM, et al. Detection of SARS-COV-2 in placental and fetal membrane samples. Am J Obstet Gynecol MFM. 2020;100133. https://doi.org/10.1016/j.ajogmf.2020.100133.
Zamaniyan M, Ebadi A, Aghajanpoor Mir S, Rahmani Z, Haghshenas M, Azizi S. Preterm delivery in pregnant woman with critical COVID-19 pneumonia and vertical transmission. Prenat Diagn. 2020. https://doi.org/10.1002/pd.5713.
La Rosa G, Bonadonna L, Lucentini L, Kenmoe S, Suffredini E. Coronavirus in water environments: occurrence, persistence and concentration methods - a scoping review. Water Res 2020;179:115899. https://doi.org/10.1016/j.watres.2020.115899.
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Jain, V., Kanchan, T. Implications of SARS CoV-2 positivity in amniotic membranes for ophthalmologists. Eye 35, 2058 (2021). https://doi.org/10.1038/s41433-020-1051-5
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DOI: https://doi.org/10.1038/s41433-020-1051-5