Amniotic membrane harvesting during COVID-19 pandemic.

To the Editor:

We read with interest the recently published article by Seah et al. [1]. While we agree with the authors that infectious risk is highest in ophthalmology clinic settings, we would like to discuss the precautions for virus transmission in amniotic membrane harvest and share our experience amidst the COVID-19 pandemic.

Most elective surgeries have been suspended globally to mitigate the spread of COVID-19. However, the expiry date of our stock of amniotic membrane coincided with the local COVID-19 outbreak in February 2020. Furthermore, local distributors of dehydrated amniotic membrane also encountered a delay in shipment. Meanwhile, we had two cases of Stevens Johnson Syndrome with total conjunctival epithelial defects requiring urgent amniotic membrane transplant. In view of this, we proceeded to amniotic membrane harvest according to the standard protocol [2] but adopted extra infection control measures.

The selected donor was asymptomatic without fever and was screened by our protocol to confirm no prior travel, occupation, contact or clustering history [3]. After obtaining consent from the patient, a deep throat sputum sample was obtained 3 days before elective Caesarean section for real-time reverse transcriptase-polymerase chain reaction for SARS-CoV2 using the E gene assay, which came back negative.

It is unknown whether amniotic membranes from infected donors carry COVID-19. Vertical transmission has been suggested to be probable but low risk and not definite [4]. Currently, there is no data on the survival of SARS-CoV-2 on cryopreserved amniotic membranes. However, the Global Alliance of Eye Bank Association recommends ocular tissue donors with confirmed or suspected COVID-19 to be excluded for harvesting [5]. Before more evidence is available, we suggest taking a more prudent approach when conducting amniotic membrane harvest during COVID-19 outbreak.