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The Capital Region of Denmark - a part of Copenhagen University Hospital

A presentation of culture-positive corneal donors and the effect on clinical outcomes

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PURPOSE: Donor-to-host transmission of infectious agents is a rare but well-recognised complication of corneal transplantation and may carry a grave visual prognosis. In this case series, we describe the clinical features and risk factors of using culture-positive donor corneas for transplantation.

METHODS: Retrospective chart review of a series of patients who underwent either penetrating keratoplasty (PK) or Descemet's stripping automated endothelial keratoplasty (DSAEK) with positive microbiology cultivation during routine assessment of donor corneal tissue obtained at the time of surgery. Donor and recipient characteristics, tissue preparation and surgical parameters, clinical signs and outcomes were registered.

RESULTS: Eleven patients who received culture-positive corneal grafts were identified: six with Candida, three with Gram-positive bacteria and two with Gram-negative bacteria. Three patients developed clinical keratitis after routine DSAEK using corneas contaminated with Candida species. The median death-to-preservation time (DPT) of these three donor corneas was 18.08 (range 18.08 to 20.90) h, while in the remaining eight donors, it was 12.27 (range 9.32 to 20.47) h. Despite the initiation of antifungal treatment, all three cases required explantation of the graft and a subsequent re-DSAEK.

CONCLUSIONS: The use of donor corneas that are culture-positive for Candida carries a risk for developing postoperative keratitis and the risk may be higher in DSAEK. Unlike the cold storage technique employed for donor corneas described in this case series, organ culture technique requires microbiological screening and supplementation of an antifungal agent which may reduce the risk of donor-to-host transmission of fungal infection.

Original languageEnglish
JournalGraefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie
Issue number1
Pages (from-to)135-141
Number of pages7
Publication statusPublished - Jan 2019

    Research areas

  • Aged, Aged, 80 and over, Cornea/microbiology, Eye Infections, Bacterial/microbiology, Eye Infections, Fungal/microbiology, Female, Graft Survival, Humans, Keratitis/etiology, Keratoplasty, Penetrating, Male, Middle Aged, Retrospective Studies, Risk Factors, Surgical Wound Infection/etiology, Tissue Donors

ID: 56462135