Rawan Saleh Alshabeeb1, Ahmed Abdullah Aldayel1, Hernan Martinez-Osorio1, Muhammad Ali Ahad2. 1. Anterior Segment Division, King Khalid Eye Specialist Hospital, Al Oruba Road, P.O. Box 7191, Riyadh, 11462, Saudi Arabia. 2. Anterior Segment Division, King Khalid Eye Specialist Hospital, Al Oruba Road, P.O. Box 7191, Riyadh, 11462, Saudi Arabia. mahad@kkesh.med.sa.
Abstract
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.
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.
Authors: Anthony J Aldave; Jennifer DeMatteo; David B Glasser; Elmer Y Tu; Bernardino Iliakis; Michael L Nordlund; Jachin Misko; David D Verdier; Fei Yu Journal: Cornea Date: 2013-02 Impact factor: 2.651
Authors: Abdullah Al-Assiri; Sabah Al-Jastaneiah; Abdulrahman Al-Khalaf; Hamad Al-Fraikh; Michael D Wagoner Journal: Cornea Date: 2006-01 Impact factor: 2.651
Authors: Jesse M Vislisel; Kenneth M Goins; Michael D Wagoner; Gregory A Schmidt; Benjamin T Aldrich; Jessica M Skeie; Cynthia R Reed; M Bridget Zimmerman; Mark A Greiner Journal: Ophthalmology Date: 2016-11-03 Impact factor: 12.079