Incidence and outcome of transplantation of fungal-culture-positive donor corneoscleral tissue in optical keratoplasty

• Published in: International ophthalmology 2021-03, Vol.41 (3), p.867-873
• Main Authors: Alshabeeb, Rawan Saleh, Aldayel, Ahmed Abdullah, Martinez-Osorio, Hernan, Ahad, Muhammad Ali
• Format: Article
• Language: English
• Subjects: Acuity; Amphotericin B; Clinical outcomes; Complications; Cornea; Corneal transplantation; Endophthalmitis; Eye; Eye (anatomy); Fungi; Fungicides; Glaucoma; Graft rejection; Keratitis; Medicine; Medicine & Public Health; Ophthalmology; Original Paper; Patients; Prophylaxis; Tissue culture; Tissues; Transplantation; Transplants; Transplants & implants; Visual acuity
• ISSN: 0165-5701; 1573-2630
• DOI: 10.1007/s10792-020-01641-9

Purpose This study aims to determine the incidence of fungal-culture-positive corneoscleral donor rim in patients undergoing keratoplasty and evaluate clinical outcomes of eyes that received these contaminated donor tissues. Methods Patients who had optical keratoplasty between 2006 and 2016 and were found to have fungal-culture-positive donor rim were included. Microbiological and eye bank records were reviewed to determine the incidence of positive fungal rim cultures. Data were collected on visual and clinical outcomes. The main outcome measures were fungal-culture-positive donor rim and development of fungal keratitis or endophthalmitis post keratoplasty. Long-term clinical outcome and associated complications were the secondary outcome measures. Results Out of 9620 cases of corneal transplants, 145 (1.5%) had fungal-culture-positive donor rim. Candida was the most common organism, cultured in 127 (87.6%) cases. There were no cases of postoperative fungal keratitis or endophthalmitis. Median follow-up was 4.8 years (interquartile range 3.8–7.2 years). Only eight cases (5.5%) received prophylactic antifungal treatment. There were 34 (23.4%) cases of rejection, 13 (8.9%) developed glaucoma, and 7 (4.8%) developed late bacterial keratitis. At last follow-up, best corrected visual acuity was 20/60 or better in 88 cases (60.7%) and 115 eyes (79.3%) had a clear graft. Conclusion The incidence of fungal-culture-positive donor rim is extremely low. The risk of developing fungal keratitis or endophthalmitis in patients who received contaminated donor tissue was almost negligible. Further studies are warranted to prove whether prophylaxis or adding amphotericin B in Optisol-GS confers any added benefit.