PMC8355891_01
Slit-lamp photographs of the patient's eyes. Conjunctival congestion and conjunctival follicles in the left eye (B) and the right eye was normal (A).
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The slit-lamp evaluation showed epiphora, conjunctival congestion, and inferior palpebral and conjunctival follicles in the left eye (Figure 1). The N protein was found in the cytoplasm and the S protein gathered around the nucleus in the cells of the left eyes (Figures 3 and S2), but not in the cells collected from the right eye (Figure S1).
Timeline of the COVID-19 infection, development of glaucoma, and recurrence SARS-CoV-2. On January 21, 2020, the patient was presented to the Hubei provincial hospital of Traditional Chinese Medicine with initial COVID-19 signs and symptoms and eventually confirmed to be positive for SARS-CoV-2 infection using RT-PCR. After normal recommended medication, the patient was discharged from the hospital on February 13, when declared negative with RT-PCR twice as per hospital criterion. However, the patient was experiencing sight darkness and spiral visual field in her left eye. On April 22, 2020, the patient was re-hospitalized displaying more severe unilateral ocular complications. With an extensive investigation the patient was found re-positive for SARS-CoV-2 with neutralizing antibodies. The ocular complication resulted in unilateral glaucoma. The investigation team further examined the patient closely, and the immunocytochemical study of both eyes was conducted on May 28, 2020. SARS-CoV-2 spike (S) or Nucleocapsid (N) protein were detected in aqueous humor of the left eye only.
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Together, these results suggested that SARS-CoV-2 was avoiding the immune clearance and still harbored at some locations in the patient's body. The timeline depiction of the current case report (Figure 2). The N protein was found in the cytoplasm and the S protein gathered around the nucleus in the cells of the left eyes (Figures 3 and S2), but not in the cells collected from the right eye (Figure S1).
SARS-CoV-2 was detected using immunofluorescence in the aqueous humor. Cells were fixed and incubated with the antibodies of SARS-CoV-2 spike (S) protein, nucleocapsid (N), respectively. This picture shows SARS-CoV-2 was detected in the aqueous humor of the left eye.
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The N protein was found in the cytoplasm and the S protein gathered around the nucleus in the cells of the left eyes (Figures 3 and S2), but not in the cells collected from the right eye (Figure S1).